Transparency Through Member Pricing Tool

Transcription

1 FALL 2014 Transparency Through Member Pricing Tool As your patients navigate the new world of healthcare insurance, they are forced to educate themselves in areas they may have previously not considered. As healthcare insurance plans and prices are increasingly viewed as a commodity, your patients won t just be learning to compare plans and insurers, but also to compare providers and facilities. Far from being a novelty, a cost calculator for healthcare services is an emerging face of healthcare reform. Blue Cross of Idaho is responding to the changing marketplace with the addition of a tool that adds transparency to healthcare pricing. Scheduled to launch in the first quarter of 2015, the cost calculator uses a member s benefits and claims data to provide true cost estimates for many healthcare procedures and services. Blue Cross of Idaho s cost calculator works in two ways; Cost Lookup allows members to search for procedures and services prior to accessing care to determine potential out-of-pocket responsibility they may incur. Ways to Save Alerts notifies members of potential savings on care they ve already received. With Cost Lookup, members can filter searches by area, estimated costs and more. The cost calculator vendor, Change Health Care, aggregates claims data from a rolling 12-month window and uses a proprietary algorithm to return cost estimates for members. Ways to Save Alerts take recent member claims and searches for potential savings based on memberspecified settings such as minimum cost savings, driving distance and more and are delivered to the member via or text message alerts. one TO one FOR HEALTHCARE PROFESSIONALS Blue Cross of Idaho is aware of the ways our cost calculator will affect our contracted providers and facilities. We have already taken steps to modify some of the tool s functionality until we can more accurately gauge its impact on our providers. As we continue to make decisions about the tool s implementation, we will provide you with more information about your profile and estimated cost results. If you have questions about the cost calculator, please contact Dan Polette, Provider Network Management representative at , ext 8894.

2 Open Communication Patients look for quality communication with providers One of Blue Cross of Idaho s many efforts to improve the quality of care for our members is to track quality of care and service concerns by members. This provides us with valuable insight regarding our members perceptions and potential knowledge gaps. Complaints are categorized in five types: quality of care, access, attitude and service, billing/ financial, and quality of practitioner office site. The largest number of complaints about practitioners Blue Cross of Idaho receives each year is in the attitude and service category. For two years in a row, more than 70 percent of complaints were in this category, and members often felt that they were not listened to. To help address this, here are a few helpful reminders about communicating with members: Give your full attention to your patients and let them know that you welcome their questions and concerns. Open communication is the key to a positive and professional relationship between you and your patients. When a patient hears bad news, understand that he or she may become overwhelmed at that moment. It can be helpful to give handouts with additional information on the condition so the patient can take it home and read over the information slowly. Try to provide information on support groups as well. Give your patients time to ask questions without interrupting. If you interrupt, they could lose their train of thought or feel that they cannot express the concerns they have about their health. If patients feel rushed at their appointments, they may also feel that they are not being heard or not valued. Write down instructions or ask the patient to repeat back what you said about his or her treatment or the plan of action. Also, try not to use too much medical terminology to make sure your patient fully understands his or her condition or treatment. Full understanding can help ensure compliance with a treatment plan. Reassure your patients that any and all questions or concerns are welcomed and valid. Remember that truly listening to your patients shows respect, understanding of their concerns or fears, and compassion. By keeping communications open between you and your patients, you are investing in your patients wellness, and they will, in turn, likely take ownership of their own health. Open communication between you and your patients can be lifesaving. 2

3 Reminder for Medicare-Medicaid Coordinated Plan Providers As part of the True Blue Dual Special Needs plan expansion, the State of Idaho requires all contracting Medicare Advantage or Medicare-Medicaid Coordinated plan providers and/or their office managers to complete mandatory training assessments. These assessments are located on the bcidaho.com provider portal with your secure logon. Select Medicare Medicaid Coordination Plan on the left side of the page then, select Online Mandatory Assessments in the center, select Tutorials and finally Certifications on the top left. Under the Community Partners track, you will see a red REQ for the three assessments: Fraud Waste and Abuse, Non-Discrimination and Cultural Competence. This training must be completed by all staff members who provide a service for a dual special needs member. The assessment completion will be automatically tracked for those who have a user ID and password for the portal. If your office has a large number of staff members who do not have a logon, please arrange to conduct the training at a monthly department meeting so your entire staff can be trained in these areas. You may either print the slides from the portal or log on and walk through the PDF images. This training is mandatory and must be completed within 90 days of becoming contracting. Please contact your external provider relations representative if you have any questions (PAP100). Blue Cross of Idaho Begins Direct Claim Entry Blue Cross of Idaho is making the billing process easier than ever with the implementation of direct claim entry. Now, you can submit your Blue Cross of Idaho professional medical claims directly through our website, bcidaho.com, with just a user ID and password. There is no software required to use this service. Please contact your external provider relations representative to schedule a training session. (Please reference PAP100.) Blue Cross of Idaho Corporate Holidays Thanksgiving Thursday, November 27 Day after Thanksgiving Friday, November 28 Christmas Day Thursday, December 25 Day after Christmas Friday, December 26 New Year s Day Thursday, January 1, 2015 Blue Cross of Idaho Enrollment Center Blue Cross of Idaho now has an enrollment center open at the Blue Cross of Idaho Meridian campus, 3000 E. Pine Ave., ready to help answer your patients questions regarding the metallic exchange plans and assist in determining which plan is best for them. Open enrollment begins November 15 and the enrollment center will be open Monday through Friday from 7 a.m. to 7 p.m. 3

4 Truven Offers Healthcare Cost Comparisons Blue Cross of Idaho has adopted a reporting tool designed to share information about comparative healthcare cost patterns within Idaho. The adjusted cost scores generated on these reports will be utilized to determine the key performance indicator (KPI) on the physician fee schedule in The adjusted cost scores will replace the current contract KPIs generic prescribing and access to care requirements (single conversion factor contract only). These reports compare practice patterns for commonly treated conditions with their peers throughout the state who practice in the same specialty. The reports are based on commercial claims submitted to Blue Cross of Idaho and exclude Federal Employee Plan and Medicare Advantage claims. These reports are not intended as a statement of the ability or quality of a physician, but strictly to reflect the relative cost efficiency of each physician within his or her specialty peer group. The reports are based on cost and utilization for a 12-month period. An adjusted cost score of 1.00 reflects the peer group average. A score less than 1.00 indicates a clinic or physician s costs for treating common conditions are lower than the average for their specialty. A score greater than 1.00 indicates a clinic or physician s costs are higher than the average for their specialty. The scores are adjusted for patient complexity to include elements such as the patient age, gender, comorbidities and severity/complexity of the medical episode grouping. Each clinic s score is available on the Blue Cross of Idaho website, bcidaho.com, with a secure log in. The report reflecting the adjusted cost score for the clinic will be listed under the Key Performance Indicator section. If you have any questions, or wish to schedule a meeting to discuss this information and review the details, please contact Becki Wallace, health systems performance specialist at or bwallace@bcidaho.com. Measuring Quality How would your Medicare Advantage patients respond to these questions? Seen within 15 minutes of your appointment time? Any problems with balance? If so, was an intervention initiated? As the practice of medicine evolves, quality measures are becoming an extremely important part of how your patients answer satisfaction survey questions. Doctor/patient discussions can help address concerns, but Medicare Advantage plans receive an annual quality rating from the Centers for Medicare and Medicaid Services (CMS) based on a specific set of questions you can ask your patients. The checklist on page 5 summarizes the CMS quality measures applied to patient care. Extensive exclusions are not included on the checklist, but are available upon request. Quality measure data is collected from multiple sources, including medical records, claims and surveys. Please consider using this checklist during future patient discussions to help get the most out of your time with your patients. 4

5 Checklist o (All) Flu Shot o (18-74) Recorded Body Mass Index (BMI) o (50-75) Colorectal Cancer Screen o (65+) No High Risk Medication Prescription (Refill) o (65+) Urine Leakage, received treatment o (65+) Problems with balance, received intervention o (65+) Advised about physical activity Women o (67+) Fracture any bone in past year, Bone Mineral Density Test or Osteoporosis prescription filled o (50-74) Mammogram every two years Diabetes o (18-75) Retinal/dilated eye exam o (18-75) Nephropathy test (urine microalbumin) unless already with documented nephropathy o (18-75) Hemoglobin A1c of 9 or below o (18+) If on diabetic med, Renin Angiotensin System (RAS) antagonist prescription filled o (18+) Fill diabetic medication at least 80% of time Hypertension o (18-85) Systolic and diastolic pressures both less than or equal to 139/89 o (18+) Fill RAS antagonist medication at least 80% of time High Cholesterol o (18+) Fill statin cholesterol medication at least 80% of time Rheumatoid Arthritis o Disease Modifying Anti-rheumatic Drug (DMARD) prescription filled Fracture any bone, during survey year o (67+) F, Within 6 months, Bone Mineral Density Test or Osteoporosis Rx Members are surveyed about the following: Able to get appointment when felt it was needed? o Yes o No Get tests and treatment when needed? o Yes o No Seen within 15 minutes of appointment time? o Yes o No Provider has needed records? Test results? o Yes o No Provider aware of most recent specialist visits? o Yes o No Provider discussed prescription medications? o Yes o No An Independent Licensee of the Blue Cross and Blue Shield Association 5

6 ICD-10 Update As you are probably aware, CMS delayed the implementation deadline for ICD-10 coding to October 1, Blue Cross of Idaho is continuing to prepare for the new implementation deadline, and we encourage the provider community not to delay either. Please work with your software vendors to ensure that you are prepared for this change by the deadline. We will continue to communicate new information to you through provider alerts and posts in the What s New section of our secure provider portal. If you have further questions, please contact your provider relations representative (PAP100). Delays in New Provider Implementation and Existing Provider Updates Blue Cross of Idaho is experiencing a delay in the implementation of new provider packets and update requests to existing provider information. Please note that the backlog is approximately eight to 10 weeks. You may check the online provider directory at bcidaho.com to verify if you have been set up in our system, or to see if your information has been updated. We are working diligently to get all paperwork processed. New Faces in Provider Information Management My name is Andrew Nelson and I am from Riverside, Calif. My wife of nine years is from Nampa and she brought me here to this wonderful valley three years ago. We have four beautiful children, including fraternal boy-girl twins born in July. I enjoy playing basketball, spending time with my kids and wife, watching sports and jogging around beautiful Kuna, where I now reside. I most recently worked at Norco-Inc. as the team lead-billing specialist. Previously, I worked in the Meridian School and Nampa School districts as a Substitute teacher and math tutor. I am a graduate of Idaho State University in exercise science (kinesiology) and received my masters in accounting from the University of Phoenix last year. I am privileged to be a part of the Blue Cross of Idaho family. I m Lee Gould and I m very happy to be part of Blue Cross of Idaho s Provider Information Management team. I ve lived in Idaho for 20 years and enjoy gardening, antiquing, photography-oriented travel with my husband and playing with our two boxers. We have three sons and a 9-year-old granddaughter. Prior to joining Blue Cross of Idaho, I was customer care manager for a regional HMO in California, manager of provider services/ premium billing for an Idaho dental plan and client services coordinator for a local TPA. I graduated from Pepperdine University in Malibu, Calif., with a bachelor s degree in business administration, and I am thrilled to be a part of Blue Cross of Idaho. 6

7 Idaho Health Care Conference Coin of Excellence 2015 Idaho HealthCare Conference SAVE THE DATE!!! Clarkston - May 5, 2015 Quality Inn 700 Port Drive Coeur d Alene May 6, 2015 Best Western CDA 506 W. Appleway Avenue Off to the Races! Idaho Falls - May 12, 2015 Shilo Inn 780 Lindsay Blvd. Twin Falls - May 14, 2015 Canyon Crest Event Center 330 Canyon Crest Drive Pocatello - May 13, 2015 Red Lion 1555 Pocatello Creek Road Boise - May 21, 2015 Boise Hotel & Conference Center 3300 S Vista Ave Any Questions? Medical Management Managed Health Care/Review, Preadmission/Admission Certification, or Individual Benefits Management and Case Management n n n Voice mail available after office hours and on holidays and weekends Medicare Medicaid Coordinated Plan True Blue Dual Special Needs Plan Hours: n 8 a.m. - 9 p.m., MT seven days a week n Member Line Dual Special Needs Plan: n Waiver Providers Support Line: Blue Cross of Idaho Help Desk Electronic Billing Errors, Error and Acceptance Reports n 8 a.m. 5 p.m. MT (Monday Friday), n 888-BCI-EDIA, or Provider Contact Center for Commercial and Medicare Advantage Benefits, Coverage and Authorization n 8 a.m. 5 p.m. MT (Monday, Tuesday, Thursday, Friday) 8:30 a.m. 5 p.m. MT (Wednesday) n Commercial: or n Medicare Advantage: or Post-service claim questions log onto our secure website at bcidaho.com and select Contact Us. External Provider Relations Questions regarding website applications such as electronic billing, eligibility, claims, authorizations, internet services or requests for FREE on-site training n or Ext. 8309: Jamie Hunihan City of Boise, St. Lukes Health Systems statewide. Counties: Boise, Canyon, Gem, Payette Ext. 8307: Kathy Brock, CPC-P Counties: Adams, Benewah, Bonner, Boundary, Clearwater, Idaho, Kootenai, Latah, Lewis, Nez Perce, Shoshone, Valley and Washington Ext. 8308: Diane Mortensen, CPC Cities: Eagle, Garden City, Kuna, Meridian, Star. Counties: Blaine, Butte, Camas, Cassia, Custer, Elmore, Gooding, Jerome, Lemhi, Lincoln, Minidoka, Owyhee and Twin Falls Ext. 7032: Angie McCormick Counties: Bannock, Bear Lake, Bingham, Bonneville, Caribou, Clark, Franklin, Fremont, Jefferson, Madison, Oneida, Power and Teton 2014 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 7