THE COMPASS. UnitedHealthcare Community Plan pays for performance. Inside This Issue. July 2015

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1 July 2015 Inside This Issue Annual Provider Satisfaction Survey 2 National Immunization Award 2 Lipid Profile 3 Chlamydia Prevalence 3 MCIR Reminder-Recall 4 Routine Screening Saves Lives 4 Michigan Cancer Consortium 5 Low Back Pain 5 Stop Smoking Programs 6 Help Patients Quit 6 Management of Adults with Depression 7 HPV Vaccine 7 Quality Team Wants to Send You Reports 8 Language Interpretation Services 8 UnitedHealthcare Community Plan pays for performance UnitedHealthcare Community Plan announced our 2015 Primary Care Physician (PCP) Pay for Performance Incentive Program in January We understand that our PCP efforts are critical to ensuring our members receive the recommended preventive health services, tests and screenings as measured by the Healthcare Effectiveness Data and Information Set (HEDIS ). The PCP Pay for Performance Incentive Program has three components: Care management fee, which is based on open panel status, overall HEDIS rate and Patient- Centered Medical Home (PCMH) designation. Quality incentives ranging from $25 to $50 per service and up to $100 for completion of a series of shots or tests. Inside this newsletter, you will find a document titled 2015 Quality Incentives. Please refer to this document for more information. 4X4 bonus program reimbursing PCPs $5 for billing specific Category II codes. *Quality incentives, including the 4X4, are paid annually. UnitedHealthcare Community Plan supports PCPs efforts to optimize the 2015 PCP Pay for Performance Incentive Program with our online portal which includes reports identifying members who need recommended services. Visit If you have any problems accessing the reports, call the UnitedHealthcareOnline.com Help Desk at HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

2 Watch your fax machine for UnitedHealthcare Community Plan s Annual Provider Satisfaction Survey UnitedHealthcare Community Plan will send our Annual Provider Satisfaction Survey via fax, beginning August 14th. The survey will be sent to a random sampling of providers. Survey results are compiled by an independent organization and are completely confidential. Please take a moment to complete the survey. We need your feedback in order to respond to any concerns your office may have. On the survey, there is an area for free form comments. Please provide as much detail as you can in order for us to develop process improvement initiatives. Thank you for your continued partnership! Kalamazoo resident Dorothy Bennett receives 2015 National Immunization Award The Michigan Department of Health and Human Services (MDHHS) recently announced that Dorothy Bennett, RN MBA, from Western Michigan University School of Medicine Clinics, has been named a CDC Childhood Immunization Champion for her outstanding efforts to promote childhood immunization in Kalamazoo, Michigan. CDC Childhood Immunization Champions were selected from a pool of health professionals, coalition members, community advocates, and other immunization leaders. One winner was selected in each of the 33 participating states and the District of Columbia Each year during National Infant Immunization Week, the CDC Foundation and CDC honor health professionals and community leaders with the CDC Childhood Immunization Champion awards. These awards acknowledge the outstanding efforts of those individuals who strive to ensure that children in their communities are fully immunized against 14 preventable diseases before the age of two. UnitedHealthcare Community Plan would like to congratulate and thank Dorothy Bennett for her efforts to promote immunizations in Michigan. For more information about the awards including profiles of other CDC Childhood Immunization Champion award winners, please visit mpions. THE MICHIGAN VOICE 2

3 Lipid profile: Remind your patients to fast If your patients are not fasting when the blood sample is drawn, only the values for total cholesterol and HDL cholesterol will be correct. The amount of the LDL (bad) cholesterol level and triglycerides can be affected by what patients have recently consumed. Please remind your patients that fasting means to avoid consuming food, beverages (except water) and medications, usually for nine to 12 hours. A fasting lipid profile should be done at least once a year. Michigan Quality Improvement Consortium (MQIC) Guidelines recommend statin therapy for primary prevention against macrovascular complications in patients with diabetes who are >40 or who have an LDL-C>100. Chlamydia prevalence and routine screening Chlamydia trachomatis (often termed chlamydia ) is the most commonly reported notifiable disease in the US. It is among the most prevalent of all sexually transmitted diseases (STDs) and has comprised the largest proportion of all STDs reported to CDC since Studies also demonstrate the high prevalence of chlamydial infections in the general U.S. population. Based on estimates from national surveys conducted from , chlamydia prevalence is 6.8% among sexually active females aged years. Chlamydia Facts Up to 40% of women with untreated chlamydia develop pelvic inflammatory disease (PID). One in five women with untreated chlamydia loses the ability to have children. 80% of women with chlamydia have no symptoms. The table below displays reported cases of Chlamydia by county in UnitedHealthcare Community Plan s service area. We are sharing the information to heighten awareness of the incidence and encourage your office to routinely screen young women for the condition. Best Practice Annually, screen women ages using a urine test for chlamydia Reported Chlamydia Cases County 2013 Total County 2013 Total Michigan 45,091 Macomb 2,574 Allegan 319 Monroe 360 Berrien 794 Muskegon 1,194 Branch 89 Oakland 3,536 Calhoun 755 Oceana 64 Cass 97 Ottawa 736 Hillsdale 65 Saginaw 1,195 Huron 47 St Clair 440 Jackson 629 St Joseph 160 Kalamazoo 1,871 Sanilac 65 Kent 3,765 Tuscola 120 Lenawee 207 Van Buren 241 Livingston 264 Wayne 15,719 Sources: Michigan Sexually Transmitted Diseases Database, STD & HIV Prevention Section, Bureau of Epidemiology, Michigan Department of Community Health; Table prepared by the Division for Vital Records and Health Statistics, Michigan Department of Community Health; Centers for Disease Control THE MICHIGAN VOICE 3

4 Raising immunization rates with reminder - recall Providers utilizing the Michigan Care Improvement Registry (MCIR) can use the Reminder-Recall (R/R) function. Generating the reminder or recall letters can assist providers in identifying individuals who will be due or are currently overdue for immunizations, and get them back into the office to make sure they are protected. The following list includes a few simple steps to ensure a bigger bang for your buck when using R/R: Enter all historical data Update addresses/patient status Utilize profile reports Flag high risk patients By entering all historical data, providers can make sure they are getting an accurate assessment of what doses are due. The registry assesses based on the doses that have been entered into the system. If a dose is in your chart, but not in MCIR, the registry will assess that dose as due because it s missing from the system. Updating addresses and patient status is another way to ensure R/R success. The letters will get to the right person and a stamp is not wasted. Routine screening saves lives Mammogram and Pap Tests are performed as screening tests in women on a regular basis, as abnormal tissue or cancer cells found early are easier to treat. The cervical cancer screening HEDIS measure is defined by the following criteria: Women age need a PAP test every three (3) years Women age need a Pap test every three (3) years which may be extended to every five (5) years if human papillomavirus (HPV) testing is completed at the same time a Pap test is performed. Women age may be EXCLUDED from the HEDIS study if there is medical record documentation of a hysterectomy with no residual cervix. Documentation of complete, total, or radical abdominal or vaginal hysterectomy is acceptable. The information can be reported by the patient with documentation in the record by the provider. Most women with cervical cancer have contracted the human papillomavirus (HPV), but not all women with an HPV infection will develop cervical cancer. There are several types of HPV which can affect the cervix, but only some of them trigger the abnormal cells that may become cancerous. Sometimes the HPV infection may disappear as part of the body s immune defense and be of no consequence. Cervical Cancer (CPT) Screening Codes ; 88147, 88148, 88155, , 88174,88175, G0101, Q0091 Or Diagnosis Code of: V72.32 or V76.2 PCPs on the plan s Pay for Performance contract receive a $35 incentive per measurement period for billing a cervical cancer screening code. Please contact your dedicated Provider Relations Advocate for questions about the cervical cancer screening HEDIS measure. Your Provider Relations Advocate will connect you to a Quality Management Nurse, if needed. Running profile reports can help providers determine their immunization rate, and can generate a list of people that the registry identifies as incomplete (this allows offices to make sure all historical shots are in MCIR). Flagging high risk patients for influenza allows sites to tailor messages and reach at-risk patients. For more information or How-To tip sheets, visit THE MICHIGAN VOICE 4

5 Michigan Cancer Consortium updates Low back pain tips for HEDIS compliance The July Michigan Cancer Consortium (MCC) Update includes cancer information for MCC stakeholders: Breast Density Notification Law and Primary Care Provider Education Modules NCI Funding Announcement: Smoking Cessation within the Context of Lung Cancer Screening Michigan Cancer Genetics Alliance HPV Vaccine Updates MDHHS Public Education Update: Make It Your Own - easy to develop health information for the populations you serve And...Quick News & Links featuring information on: o New HPV vaccine effectively prevents 90% of cancers caused by HPV in girls and boys o CDC's new skin care awareness tools for four different audiences o Oral cancer deaths in U.S. in 2011 attributable to cigarette smoking o Monitoring noncancerous lung nodules with annual CT scans MCC Calendar of Events Please be sure to visit the MCC Calendar of Events for ongoing and updated postings for July and moving forward: e/calendarofevents.html Please MCC-related meetings or events you would like included in the calendar to info@michigancancer.org. Which patients are in the measure? How is someone considered compliant? Patients, ages 18 50, who have a new primary diagnosis of low back pain in an outpatient or ED visit, are included in this HEDIS measure. A positive HEDIS scenario for the provider is the number of members who did not receive an imaging study within 28 days of the diagnosis back pain, lumbago and/or associated back pain diagnosis listed below in the ICD- 9 diagnosis codes. The intent of this measure is to evaluate appropriate utilization of diagnostic imaging studies. Clinical guidelines indicate that diagnostic imaging is not necessary for most patients with new onset low back pain. This measure is based only on claims and encounter data submitted. Exclusions include Cancer, Neurologic Impairment, Recent trauma/injury, IV Drug Abuse. How can you improve your score for this HEDIS measure? Some ideas for improving HEDIS scores for this measure are: Avoid ordering diagnostic studies in the first 6 weeks of new onset back pain in the absence of red flags (e.g. cancer, recent trauma, neurologic impairment, or IV drug abuse). Use of correct exclusion codes where necessary (e.g. code for cancer, trauma/injury, or other secondary diagnoses if these are why you are ordering the studies). Description ICD 9 Diagnosis Code for Exclusions Cancer , , V10 Trauma , , , , , , 929, 952, IV drug abuse , 304.4, Neurologic impairment , Which codes add the patient to the HEDIS Study? CPT and ICD-9 Codes used on date of delivery to indicate the diagnosis of low back pain and an imaging study: Description CPT Codes Outpatient Visit , , , , , , , , 99385, 99386, 99395, 99396, , 99411, 99412, 99420, 99429, 99455, ED visit Imaging Studies 72010, 72020, 72052, 72100, 72110, 72114, 72120, , 72141, 72142, , 72156, 72158, 72200, 72202, ICD-9 Diagnosis Codes Low Back Pain 721.3, , , , , , , 724.2, 724.3, 724.5, 724.6, 724.7, 738.5, 739.3, 739.4, 846, THE MICHIGAN VOICE 5

6 Stop smoking programs ( QUIT or ) UnitedHealthcare Community Plan has a Smoking Cessation Program for our members. If your UnitedHealthcare Community Plan patients are ready to quit, call QUIT (7848). We cover smoking cessation medication (pills, patches, inhalers, nasal spray and gum). A personal health coach is also available to help your UnitedHealthcare Community patients stop smoking. Encourage your UnitedHealthcare Community Plan patients to call QUIT (7848) today. Help your patients quit smoking You can play a key role in fighting tobacco use, the number one cause of preventable death and disease in the United States. You know the drastic effects that smoking can have on your patients' health. You know the toll secondhand smoke can take on their children and families. Many smokers want to quit. Getting started often takes support and motivation from trusted sources, like you. The CDC s Tips From Former Smokers (Tips) campaign can be a conversation starter. The campaign offers resources for you as well as your patients. With the support of CDC's materials, you can help more patients live smokefree lives. 1 Visit for a variety of materials to assist your practice and your patients. The CDC offers a printable, pocketsized tobacco intervention card: ASK about tobacco use: Do you currently smoke or use other forms of tobacco? ADVISE the patient to quit: Quitting tobacco is one of the best things you can do for your health. I strongly encourage you to quit. Are you interested in quitting? REFER the patient to resources: IF READY TO QUIT: Provide direct referrals to resources that will assist the patient in quitting. Provide direct referrals. Prescribe medications, if appropriate. There's strong evidence that advice from a health care professional can more than double smoking cessation success rates. And research shows that patients are more satisfied with their health care if their primary care provider offers smoking cessation interventions even if patients are not yet ready to quit. 2 1 Centers for Disease Control, aign/tips/partners/health/hcp/ 2 American Academy of Family Physicians, THE MICHIGAN VOICE 6

7 Primary care diagnosis and management of adults with depression MQIC released updated recommendations to Primary Care Diagnosis and Management of Adults with Depression Clinical Practice Guidelines. Updated recommendations include: Eligible population for screening: Adults 18 years or older with high risk for major depressive disorder Including conditions such as: o Prenatal and postpartum; o Chronic medication use, disabling illness, and/or pain; o Anxiety Assess: Post-partum within 3-8 weeks of discharge using the Edinburgh Postnatal Depression Scale Management of patients who are prescribed antidepressant medication: Consider referral to Behavioral Health Specialist when: o Diagnosis is uncertain or complicated by other psychiatric factors (e.g. bipolar disorder, psychosis, substance abuse) Monitoring medication: Monitor medication frequently (e.g. every two weeks) and adjust to a therapeutic level as assessed by clinical data not to exceed the highest recommended dose. Medication should not be abruptly discontinued. If no response after approximately 2-3 weeks on therapeutic dosage, increase dosage as tolerated and begin new observation period. If no response after approximately 2-3 weeks on maximal dosage, then switch antidepressant. If partial response on maximal dosage, then switch antidepressant or augment with additional agent. Primary Care Physicians (PCPs ) play an important role in screening for and treating depression. UnitedHealthcare Community Plan recommends the use of PHQ-9 Questionnaire as a depression screening tool. The Tool is available online as part of the MacArthur Initiative on Depression & Primary Care at Dartmouth and Duke at: You will find useful information and a Depression Management Tool Kit on their website that includes the following: Recognition and Diagnostic Information Patient Education Materials Treatment Information Monitoring and Follow-up Information Bibliography Please remember: UnitedHealthcare Community Plan covers 20 outpatient behavioral health visits per year. Screen for depression in asthmatic, diabetic and post-partum patients and refer patients for behavioral health services if needed. You can find UBH behavioral health providers in the plan s online Provider Directory available at octor/first.jsp?xplan=uhcmi&xtitle= Doctor. Look for the link at the bottom of the page for Behavioral Health/Mental Health providers. Depression clinical practice guidelines are available in the clinician toolkit listed above and are also available on the MQIC website at HPV Vaccine Gardasil 9 Gardasil-9 prevents many cancers caused by human papillomavirus (HPV) infections, including: cervical cancer in females, vaginal and vulvar cancers in females, and anal cancer in females and males. In addition to these cancers, Gardasil-9 also prevents genital warts in both females and males. In the U.S., about 12,000 women get cervical cancer every year, and about 4,000 women die from it. Gardasil-9 can prevent most of these cancers. HPV infection usually comes from sexual contact, and most people will become infected at some point in their life. About 14 million Americans get infected every year. Many infections will go away and not cause serious problems. But thousands of women and men get cancer and diseases from HPV. Gardasil-9 is one of three FDAapproved HPV vaccines. It is recommended for both males and females. It is routinely given at 11 or 12 years of age, but it may be given beginning at age 9 years through age 26 years. Three doses of Gardasil-9 are recommended with the second and third dose 1-2 months and 6 months after the first dose. Vaccination is not a substitute for cervical cancer screening. This vaccine does not protect against all HPV types that can cause cervical cancer. Women should still get regular Pap tests. THE MICHIGAN VOICE 7

8 Reminder: Our quality team wants to send you reports via We recently sent you a fax alert. As a reminder, the UnitedHealthcare Community Plan local quality team wants to send you Healthcare Effectiveness Data and Information Set (HEDIS) Gaps in Care report via secure to support your offices: 1. Quality Incentive Receivables and Care Management Fee 2. Member education and outreach efforts 3. Improve your practice s HEDIS outcome rates If you have not already done so, please fax the following information to : Provider name TIN NPI 2 business addresses to ensure coverage. Contact name If you have questions, please call Customer Service at Language interpretation services We want to ensure accurate communication between members, health care providers and our health plan staff. We provide free translations services to members and providers. We use the AT&T Language Line and can provide interpretation services for over 130 languages. For more information about the AT&T Language Line, please contact Customer Service at regarding use of an interpreter. Michigan Newsletters Members: Providers: THE MICHIGAN VOICE 8

9 Quality Incentives Measure Procedure Code (CPT) Diagnosis Code (ICD-9) Qualifying Event Age Incentive Asthma Member filled an asthma control medication during the measurement year (must be from the UHC formulary) 5-64 years $50 One per quality measure period. Immunizations (Administration fee is paid in addition to incentive on FFS basis via claim payment.) 1 per Quality Measurement Period Per Program Customer DTaP (Up to 4 in a series) IPV (Up to 3 in a series) MMR (1 in a series) HiB (Up to 3 in a series) Hepatitis B (Up to 3 in a series) VZV (1 in a series) Pneumococcal conjugate (Up to 4 in a series) Combo 3 Completion 4 DTaP 3 IPV 1 MMR 3 HIB 3 HepB 1 VZV 4 Pneumococcal conjugate Lead Screening Well Child Care Early Childhood 1-5 visits Early Childhood 6 or more visits Before 2 nd birthday Months Months Childhood Years Adolescent Years Breast Cancer Screening G0202 G0204 G0206 OR Diagnosis code of: V76.11 or V Years 0 for complete series $50 One per quality measure period. $25 per service; one per quality $100 per completion of 6 visits; one per quality $25 per service; one per quality $25 per service; one per quality $50 one per quality

10 Quality Incentives Measure Cervical Cancer Screening Procedure Code (CPT) Diagnosis Code (ICD-9) Qualifying Event G0101 Q0091 OR Diagnosis code: V72.32 or V76.2 Only covered services as defined by this Agreement are eligible for reimbursement, regardless of coding submitted at 100% of Prevailing Michigan Medicaid Rates. UnitedHealthcare Community Plan will pay for a well visit in conjunction with a sick visit one time per year for members over 2 years old when billed on the same claim. UnitedHealthcare Community Plan will pay up to nine sick and well visits for children until age 24 months when billed on the same claim. To qualify for a Quality Incentive Fee payment, the service must be delivered in strict accordance to HEDIS guidelines. Timeframes and enrollment criteria for each measure must be met. Immunization(s) should be administered based on CDC guidelines. Procedure codes are derived from MDCH Practitioner database: OPPS codes may not be listed. Age Years Chlamydia Screening Years Prenatal Care Multiple qualifying CPT codes as defined by HEDIS specifications for the applicable Quality Measurement Period Post Natal Care Multiple qualifying CPT codes as defined by HEDIS specifications for the applicable Quality Measurement Period Diabetic Measures: Diabetic members must have at least 2 face-to-face (i.e. E&M) claims in a 2 year period with a diagnosis of , , , or Diabetic Eye Exam (by an eye care professional) Incentive $35 one per quality $35 one per quality Any $100 Any $100 All Incentives: One per quality measurement year , ; HCPCS S0620-S Years $25 HbA1c Testing Years $25 Nephropathy Years $25 Completion of all Diabetic Screenings Above (Eye Exam, HbA1c & Nephropathy) Years $100