Provider Services and Network Management Newsletter

Transcription

1 A healthier you. A healthier community. In this Issue: Provider Services and Network Management Newsletter Fall 2017, Volume2 : Issue2 We won the RFP... Pg. 1 Care Management... Pg. 2 CAHPS... Pg. 3 Incentives... Pg. 3-4 Newly Added Providers... Pg. 5 Welcoming our new VP... Pg. 5 Network Management team... Pg. 6 Contact Information... Pg. 7 And the award goes to... NextLevel Health Plan!!! The Illinois Department of Healthcare and Family Services has awarded a contract to NextLevel Health for Option B (Cook County ONLY), to provide services under its Medicaid Managed Care Program. The executed contract will be effective January 1, 2018; the initial contract term is four (4) years and will include the option to renew for up to an additional four (4) years. What does this mean for you as a participating provider? There are no changes to your current agreement NextLevel Health will continue to coordinate services in support of all populations covered New Member populations include: Managed Long Term Services & Support (MLTSS) High Needs Children Medicaid Managed Care NEW Program name is HealthChoice Illinois 1

2 Integrated Care Management NextLevel Health provides Integrated Care Management services across the continuum of care. This includes medical, behavioral health, social services, long-term services and supports (LTSS) and ancillary providers through a communitybased approach to improve health outcomes for our Members. The program includes a systematic approach for the development of an individualized care plan that includes member and family goals and education. Our care management team actively link members with providers and support services as well as outcome monitoring and reporting to the Primary Care Provider (PCP). The PCP is included in the development of the care plan as appropriate to ensure the plan incorporates medical and behavioral health treatment plans and other o bservations made by the provider(s). With an interdisciplinary care team approach, NextLevel Health augments the role of the Primary Care Provider (PCP) to improve the health and quality of life for Members with complex health conditions. The approach encourages self-management techniques where appropriate and provide education to improve the Member s overall understanding of his/her condition(s). A care team member is available to help providers improve the health of NextLevel Health Members. We look forward to hearing from you about which Members you believe could benefit from the services of our care management team. For more information, please contact our Integrated Care Management team at A healthier you. A healthier community. 2

3 CAHPS Results The Consumer Assessment of Health Providers and Systems (CAHPS) provides access to survey results showing patient perceptions of their care and brings national attention to measured outcomes. CAHPS surveys ask consumers and patients to report and evaluate their experiences with their health care providers and plans. These surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. According to the CAHPS Member Survey findings, NextLevel Health Members in the ICP (Integrated Care Plan) program reported 82% performance rating of their Personal Doctor, which is above the CAHPS 5.0 member survey benchmarks. Also, 76% of this population reported that their doctor always communicates well. NLH appreciates the hard work of the providers in our network and thank you for your continued dedication to the Members we serve. Reminder! We strongly encourage our Provider Community to remind NextLevel Health Members to come in for their annual visits. Providers please continue to send us your updated monthly rosters and notify us immediately of any changes at NextLevel Health Incentive Programs Member Incentives NextLevel Health Incentive Program was designed to enhance and encourage our Members to make informed decisions about their health. Our ultimate goal is to create Members who are active participants in our health care system. NextLevel Health promotes, tracks and offer incentives for member engagement that may result in improved health outcomes for Members. 3

4 The program also provides incentives for Members who take an active approach to services that prevent future illness. The NextLevel Health Wellness Incentive Program encourages that the following important services may result in better outcomes for engaged Members, or prevent future illness: Health Risk Screen: Members who complete a Health Risk Screen and who are classified with a High or Moderate Risk-level will earn a $15.00 gift card, plus an additional $10.00 if the member requires a comprehensive care plan. In order to receive the additional $10.00 for the care plan, the member must collaborate with his or her assigned care manager to develop his/ her individual care plan. The member must also agree to sign and date the care plan. Prenatal/Postpartum Incentive: If a NextLevel Health member is pregnant and agrees to participate in care management, the member can earn up to $ in gift cards based on the prenatal and post-delivery appointments Other member incentives include colorectal cancer screenings, diabetic care plan, breast cancer screenings, depression screenings... For additional information related to Member incentives, please call the NextLevel Health Member Services Department at Provider Incentives In an effort to encourage our providers to continuously provide appropriate and quality health care, NextLevel Health offers providers Encounter Bonus Payments for the following services: Childhood and Adolescent Immunizations Well-Child Visits Adolescent Visits Blood Lead Testing Breast Cancer Screenings Cervical Cancer Screening Chlamydia Screening Comprehensive Diabetes Care Prenatal Care Postpartum Care Positive Pregnancy results Health Risk Assessment For more information regarding our Provider incentive program, please contact Denise Kreuter, Director of HEDIS and Quality, at Denise.Kreuter@nlhpartners.com. A healthier you. A healthier community. 4

5 Newly Added Providers We are excited about our newly contracted providers that recently joined our network. These providers will provide more access for our Members throughout the communities we serve. Below is a list of the new hospitals and FQHCs in our network: Chicago Family Mercy Hospital and Medical Center University of Chicago Medical Center (Pediatric & Transplant only) MacNeal Hospital Westlake Hospital Weiss Memorial Hospital West Suburban Hospital Welcome Theodore W. Dixon, III to our Provider Network Services Team We are pleased to introduce Theodore W. Dixon III as our new Vice President of Provider Network Services. Dixon is a health care leader with a record of results in Medicaid, Medicare, physician practice management and government relations for managed care organizations. Before coming to NextLevel Health, Dixon served as the Network Director Illinois for Jencare Neighborhood Medical Centers. There he contracted with national and local health plans serving Medicare Advantage populations to increase Member assignment to the Practice. Additionally he was responsible for developing alliances and expanded access to primary care physicians, specialists, hospitals and other health care professionals for a senior population of adults. Serving as Vice President of Provider Network Services for NextLevel Health, Dixon will be responsible for directing the strategic development and maintenance of a regional and statewide networks of providers. He will oversee how NextLevel Health interfaces with providers and will identify opportunities to support clinical operations and population health management. Dixon s goal for NLH s Provider Services and Network Management team, is creating an environment where team members feel empowered to provide the highest level of responsiveness to both our Members and Providers. Doing this will enable us with the opportunity to grow our membership through multiple streams including direct contract, provider engagement, and member selection. Theodore W. Dixon III VP Provider Network Services 5

6 NextLevel Health Provider Network Management Team Meet Your Provider Representatives If you know a Medicaid provider that you would like to recommend to join the NextLevel Health network, please have the provider complete the interest form on our website at the following link: OR us at Provider.Services@nlhpartners.com for more information. 6

7 Contact Information Phone: Fax: Contract Manager: Tina Barksdale Ext. 959 Provider Data Manager: Dawn Proctor Ext. 462 PhysicianEngagement: Jocelyn Carroll Ext A healthier you. A healthier community. 7