VOLUME 04 SEPTEMBER Provider Newsletter

Transcription

1 Provider Newsletter People First. That s Our Policy.

2 HEALTH INSURANCE THAT MAKES A DIFFERENCE YourCare is a not-for-profit health insurance organization that serves Western New York and the Finger Lakes regions with access to affordable healthcare coverage through plans like Medicaid Managed Care, Child Health Plus, and the Essential Plan, backed by the nearly 50 years experience of their parent company, Monroe Plan for Medical Care. Introduced August 1, 2015, YourCare Health Plan is a not-forprofit subsidiary of Monroe Plan for Medical Care. Both YourCare and Monroe Plan pride themselves on putting members first through compassionate, patientcentered service, and are committed to meeting current and prospective members where they work, live and play. Through embracing a highly collaborative approach to working with a vast network of local, respected providers and community organizations to coordinate care, improve health outcomes and enhance quality of life, both YourCare and Monroe Plan are working together to facilitate access to quality health care for all area residents. Mission driven, YourCare and Monroe Plan share a unique approach to providing thorough and extraordinary care to every single member. P A G E 1 YourCare focuses exclusively on the safety net population. YourCare offers Medicaid Managed Care, Child Health Plus, and Essential Plan to eligible residents in seven counties (Allegany, Cattaraugus, Chautauqua, Erie, Monroe, Ontario, and Wyoming) across the Greater Buffalo and Rochester areas. Not only does YourCare offer affordable health insurance, we also make each of your patient s needs a priority. That means we ll help them understand which plans they qualify for and if they need assistance getting access to things like food, clothing, and transportation, we can help with that, too. Excellent care is the forefront of the focus of every provider with which we contract. Let us help your patients find out if they qualify for one of our free or low-cost health insurance plans recommend that they stop by one of our offices (see listings below) or give us a call We can help your patients get one step closer to getting the care they need for their health and for their lives.

3 YourCare Health Plan Offices: Rochester-Headquarters Buffalo-Amherst 1120 Pittsford-Victor Road 6400 Sheridan Drive, Suite 120 Pittsford, NY Buffalo, NY Rochester-Downtown Buffalo-Downtown 16 West Main Street 446 Main Street Rochester, NY Buffalo, NY QUALITY Flu season is upon us! Don t forget to give your patients their flu shots! CDC Recommends: A yearly flu vaccine for everyone 6 months and older by the end of October, if possible. Prompt treatment with antiviral drugs for people who are very sick or people who are sick and at high risk of flu complications. Projected availability for how much influenza vaccine will be available for Projected 151 million to 166 million doses of injectable flu vaccine P A G E million doses of thimerosal-free or preservative-free influenza vaccine 119 million doeses of trivalent (three-component) and quadrivalent (fourcomponent) flu vaccines Haven t purchased the influenza vaccine for season yet? Most preparations of the vaccine should still be available for purchase. Contact your local distributors and local vendors about remaining supplies. Don t Pooh-Pooh Fecal Occult Blood Tests According to the CDC, colorectal cancer (CRC) is the second leading killer among cancers that affect both sexes. Because early detection is such an effective tool in the treatment of this disease, organizations including the U.S. Preventive Services Task Force recommend regular screening for CRC for individuals at average risk from age 50 to 75. While screening rates have been increasing, New York State alone is still a half million people short of its goal of having 80% of people up-to-date with CRC screenings. YourCare Health Plan has been trying to do its part to help increase the number of people getting CRC screenings. In July 2017, we participated in a blitz campaign to inform our members about the importance of CRC screenings and the different types of tests they can talk to their doctors about. Approximately 1,000 members in the age range for which screenings are recommended were called and/or sent letters. (For further information

4 about the campaign or copies of the letters, please contact Donna Morris, R.N. Phone # ) Traditionally, the method of getting patients screened has been through the use of colonoscopies, which are recommended only once every 10 years. While the continued use of colonoscopies is still encouraged, many patients are uncomfortable with the idea of getting such an invasive test done, causing them not to do any type of CRC screening. So, next time one of your patients is running behind on CRC screenings, please offer them the option of an annual fecal occult blood test. Our members can now earn a $25 gift card when they complete a colon cancer screening (Men & Women, Age 50+). U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. (2017, February) Fast Facts: Colorectal Cancer Screening Saves Lives. Retrieved from colorectal/pdf/sfl_inserts_fastfacts.pdf U.S. Preventive Services Task Force. (2017, June) Final Recommendation Statement: Colorectal Cancer: Screening. Retrieved from uspreventiveservicestaskforce.org/page/document/ RecommendationStatementFinal/colorectal-cancerscreening2 P A G E 3 New York State Department of Health. (2017, March 1) New York State Colon Cancer Screenings increase by 100,000 [Press Release]. Retrieved from cancer_screenings_increase.htm POPULATION HEALTH MANAGEMENT AND QUALITY Talking to Parents About HPV Vaccine The Centers for Disease Control (CDC) advises that health care providers recommend the HPV vaccination in the same way and on the same day as all adolescent vaccines. You can say, Now that your child is 11, he/she is due for vaccinations today to help protect from meningitis, HPV cancers, and pertussis. Remind parents of the follow-up shots their child will need and ask them to make appointments before they leave. Supplemental Information: CDC s healthcare provider tip sheet for responses to parents FAQs regarding the HPV Vaccine:

5 ADHD Do not let your patient leave without making an appointment Schedule follow-up for a new ADHD script within 30 days It is important for children ages 6-12 who are newly diagnosed and starting new ADHD medication to have a follow up appointment within 30 days. How do you reach this goal? Have a plan when you prescribe a new ADHD medication to your patient. Here are some helpful tips: Schedule your patient within 21 days or less to be sure they will follow up well-before the 30 days required. This also gives the patient extra time if they need to reschedule. Educate your scheduling department about the requirement of 30 days or less for ADHD follow up appointment. 31 days is too late. If your patient took a summer break from ADHD medication and it has been more than 120 days from the last refill, it will be considered a new ADHD medication and needs a follow up visit before 30 days. -The placard can be copied and used in your office for the scheduling staff. P A G E 4 The placard is from YourCare Health Plan pediatric toolkit; if you would like copies for your office please contact Lynn Matuszewski at or Amie Hampton at Back to School 2017 Did your patient have a well child visit yet? Flip that appointment! Make every encounter count! It s that time of year when children will need back to school well child visits. Immunizations may be required for schools, daycares and sports. It is also important to review anticipatory guidance with a parent and the child. Fun Facts Did you know that you can FLIP that sick visit into a well child visit and YourCare Health Plan will pay for both services? This is an opportunity to catch those children who come in only for sick visits. Did you know YourCare Health Plan will pay for our members to have a well child visit each calendar year and not just anniversary year? Did you know YourCare Health Plan has a new adolescent incentive for children ages 9-12? If an adolescent comes in for a well child visit in 2017 and the provider discusses Tdap, meningococcal and HPV immunizations with

6 them and the provider signs the adolescent incentive form, the child will be eligible for a $25 Walmart gift card. The completed adolescent incentive form needs to be faxed or mailed to YourCare Health Plan. -The placard can be copied and used in your office for the scheduling staff. The placard and the adolescent incentive forms are from the YourCare Health Plan Pediatric toolkit; if you would like copies for your office please contact Amie Hampton at or Lynn Matuszewski at PROVIDER RELATIONS Health Home Program Interested in learning more about Health Home options? Did you know that YourCare Health Plan s parent company, Monroe Plan for Medical Care, offers Health Home Care Management Services? A Health Home is not a place- it is a group of health care and service providers that work together to make sure your patients get the care and services they need to stay healthy. Once a patient is enrolled in a Health P A G E 5 Home, he or she is matched with a care manager who develops a plan of care, sets appointments, and creates a path to better health. Often times, services include support with the following: mental health and substance abuse, housing, food, transportation, other social services and much more. Monroe Plan for Medical Care provides these care management services free of charge to those eligible for them and enrolled in any New York State Medicaid health plan. Patients who benefit from this support typically have chronic health problems, and cannot find providers and services to assist them with their needs. If you are looking to help your patients enroll in a Health Home program, please direct them to contact Monroe Plan for Medical Care, or tirage@monroeplan.com. Early Elective Deliveries Medicaid payments for early elective deliveries were subject to a 50 percent reduction in payment in Effective July 1, 2017 and September 1, 2017, respectively, Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) will further reduce payment for early elective deliveries. The increased penalty reflects the Medicaid program s commitment to providing high quality prenatal care by ensuring appropriate delivery for both mothers and babies.

7 The penalty for early elective deliveries will increase from a 50 percent reduction to a 75 percent reduction in reimbursement for claims for early elective deliveries prior to 39 weeks gestation. Codes: 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, or require modifier. U8- Delivery prior to 39 weeks of gestation U9- Delivery at 39 weeks of gestation or later FROM YOURCARE PARTNERS Beacon Health Incorporating Suicide Awareness and Prevention in Your Practice September is National Suicide Prevention Awareness month, a month during which the National Alliance on Mental Illness (NAMI) and providers across the country work to provide education, increase awareness and reduce the stigma associated with suicide. More than 1 million people in the United States attempt suicide each year, with more than 44,000 deaths by suicide annually. Despite these statistics, the topic of suicide remains taboo and is often left in the dark, shrouded with stigma and shame. Unlike so many other public health issues, suicide is both preventable and treatable, and we as providers can help. P A G E 6 How can I learn about suicide? Educate yourself about factors that place someone at increased risk for suicide Learn about mental health disorders that may affect suicidal ideation and behavior Familiarize yourself with recommended treatments for suicidal behavior, including evidence-based therapist and psycho-pharmacological interventions Reach out to a mental health or suicide awareness organization for more information: National Alliance on Mental Illness (NAMI), National Institute of Mental Health (NIMH), National Suicide Prevention Lifeline, American Foundation for Suicide Prevention (AFSP), How can I assist with suicide prevention in my practice? Engage in depression and suicide screening as a routine practice Know the warning signs that someone is in imminent danger for suicide and seek out emergency resources if necessary ( Mental-Health-Conditions/Related-Conditions/Risk-of-Suicide/)

8 P A G E 7 Consider placing stickers or fliers in your office that indicate your practice is a safe place to discuss thoughts of suicide Have resources on hand for patients, including educational brochures and crisis resource information such as the National Suicide Prevention Lifeline ( TALK) For more information on Beacon s Zero Suicide Initiative and additional resources, please visit or contact us at People first. That s our policy. FOLLOW US