IEHP More Than DOUBLES Incentive for Adolescent Checkup

Earn $200 Incentive to Keep New Moms Healthy The time after delivering a baby is an exciting one for new moms and it s an opportunity for IEHP s physicians to keep patients on track for good health. IEHP offers resources and guidelines to help physicians provide consistent postpartum care (21 to 56 days after delivery). This incentive is open to all PCPs and OBs who see women who have given birth. PO Box 1800 Rancho Cucomonga, CA 91729-1800 www.iehp.org Physician Newsletter, Issue #21 Here are key areas to review at the postpartum checkup: Anemia Signs of excess fatigue, unusually rapid heartbeat, shortness of breath, hard time concentrating, and dizziness. Birth control/sexual health Breastfeeding Complications Immunization Post-partum depression If feelings run too low at 4 12 weeks, it may be the onset of depression.* Weight & meal routine Ask patient about eating habits, sleep and exercise. Using the New Rx PA Form Yet? Be sure to download the new Pharmacy Rx PA universal form (formerly called PER) from the Provider Services page at iehp.org. Choose Forms (in the left column), then Pharmacy Forms. In the list of Pharmaceutical Services Forms, select Prescription Drug Prior Authorization (Rx PA) Form. * Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) NEW Referral Form for Mental Health Services IEHP recently updated its PCP Referral Web form to add seven new fields. Physicians like you use this form to make referrals to the Behavioral Care Management Team that reviews mental illness cases. What you need to know: If you believe the non-formulary drug is necessary for the Member because of a Member s condition or the failure of formulary medication, submit the Rx PA directly to IEHP. To ensure your forms get processed smoothly, please keep these points in mind: Page 3 What Therapies Are Appropriate to Manage Pain? Providers can fax the Rx PA form directly to the IEHP Pharmacy Team at (909) 890-2058. Page 4 For our IEHP Dual Choice Members, you can use the Coverage Determination Form as required by CMS. However, IEHP will accept the Rx PA form for the Medicare Members. Call IEHP Pharmaceutical Services at (909) 890-2049 for details. Do specify types of services requested. (e.g., therapy/counseling, psychiatric consultation). Do know that you can refer members for Case Management. If you believe a Member has a developmental disorder, do select this from the drop-down menu and attach any clinical findings. Don t submit a referral (by Web form) for Members experiencing active suicidal or homicidal ideation. Call IEHP for immediate assistance, redirect Member to ER or call 911. IEHP Enrollment As of January 2015 5 Provider Relations Team Call: (909) 890-2054 or Fax: (909) 296-3550, Mon. - Fri. 8am - 5pm Email: ProviderServices@iehp.org Medi-Cal... 994,665 Medicare DualChoice (HMO SNP)... 1,523 IEHP DualChoice Cal MediConnect Plan... 21,551 Healthy Kids...903 Questions? Provider Relations Team Phone: 909-890-2054 Fax: 909-296-3550 ProviderServices@iehp.org Total...1,018,642 2015 Inland Empire Health Plan All Rights Reserved. PS-15-01908 Pay for Performance (P4P): Where Adult Patients Can Get The form needs to be filled out completely. IEHP may deny requests if they do not include all information required. Dos and Don ts Preventive care for adolescents is so important that IEHP is increasing its P4P incentive for their annual checkups. While your adolescent patient is in your office, be sure to use this opportunity to see if they re due for shots (e.g., whooping cough, HepB/Hib). Page 2 Community pharmacy will be contacting your office directly if you prescribe a drug that is not on the IEHP Formulary. Physicians should respond to community pharmacy requests in a timely manner to change to formulary medications. The pharmacy can no longer submit Rx PAs without medical justification from you. The Rx PA form should be used to request non-formulary prescription drugs for Members in Medi-Cal and Healthy Kids. Fill out these fields completely to give a clear clinical picture about the Members presenting mental health symptoms. This information also will be used to triage Members to County services (if appropriate) and/or to make referral authorizations to IEHP behavioral health providers that will best meet the Members needs. You re not expected to diagnose just add details in these new fields. Submit the PCP Referral Web form for processing online at iehp.org. Please do not fax the forms. They will no longer be accepted via fax. Annual Checkup Is Key to Preventive Care As of January 1, the DMHC requires all health plans to use the new universal Prescription Drug Prior Authorization request form for Members of Medi-Cal and Healthy Kids only, not Medicare. $200 for post-partum assessment (if done 21 56 days after delivery) Incentives are paid within 30 working days of receiving a complete PNO (Pregnancy Notification/ Outcome Report) form submitted online via iehp.org P4P Program site. IEHP More Than DOUBLES Incentive for Adolescent Checkup Physician Newsletter Incentives for Postpartum Services: Winter 2015 6 Starting January 2015, IEHP is more than doubling its P4P incentive from $20 to $50 for the annual Adolescent Well-Child Exam. Physicians can receive incentives directly through P4P under one or more of eight (8) program components, such as those shown here: Annual Physical Adolescent / Well-Child Visit $50 for each Adolescent Well-Child Exam (by assigned PCP from ages 11 through 19th birthday) $40 for each Well-Child Visit (by assigned PCP from birth to 7th birthday) $4.50 for each eligible immunization $9 for HepB/Hib combo vaccine and/or Td shot $7.50 for TB test and reimbursable up to a maximum of two times per year with a minimum of 30 days in between each TB test See PM160 Immunization Codes Schedule for a complete list of reimbursable vaccines. NOTE: The PM160 form (version 8) must be completed for all and/or Well-Child Visits provided to IEHP Members under the age of 19. See Adolescent Checkup, Page 3 IEHP extends our best wishes for a healthful New Year. The year 2015 is of great significance as we drive improvements in care delivery while serving as careful stewards of public funds. Our network of physicians continues to expand and we continue to improve how we work together and prioritize programs. In this issue, we offer information and assurance that we re available to support the care you provide. The cover story announces an increase in a key P4P program. On page 3, you ll find guidance on where to direct your adult patients for their immunizations. And on page 4, you can read about conservative therapies for Members who need help managing their pain. Dr. William Henning, Chief Medical Officer

Why an Annual Checkup is Key to Preventive Care The New Year is a great time to get your IEHP patients in for their annual exam. It not only keeps them on track for maintaining health, but it s also a chance for you to notice symptoms of frequently undiagnosed conditions such as diabetes or asthma. Here s a summary of what physicians typically check, based on a Member s age: $50 for Adolescents (ages 11-19th birthday) TdaP County Dept. of Public Health (San Bernardino) 1-800-722-4777 http://1.usa.gov/1zfcyd7 When it comes to treating pain, many possible approaches are available. With a variety of new pain meds offered and with so many people demanding immediate relief, it may be difficult to choose a moderate path. However, a conservative approach is preferred. - or 1-888-246-1215 http://www.rivco-familycarecenters.org/ locations.aspx Here are resources and tips to help with pain management: To start the New Year off well, IEHP increased its yellow card P4P incentive from $100 to $150. IEHP wants to help you encourage patients to have full immunization compliance by age 2. Annual Wellness Visit: (if Member has had Part B more than 12 months) Create/update a prevention plan Review medical and family history Offer to discuss Advance Directive Select pharmacies in IEHP s network* IEHP Member Services: 1-800-440-4347 Yellow Card Bonus -- Now at $150 Welcome to Medicare Visit: (within the first 12 months, if Member has Part B) Medical and social history Providing a written plan preventive care, vaccines, and screenings * Medicare wellness visit covered 1X/year (11 full months must pass between visits) Shingles/Zostavax To Help Manage Pain, Take Conservative Approach First Who to contact for more information *Walgreens, Rite-Aid and select independent pharmacies (call the local pharmacy or IEHP Member Services to find out if it is in the IEHP network). For IEHP Medicare DualChoice Members (HMO SNP) Ages 65+* (plus routine tests named above) Adolescent Checkup... (from Page 1) To Participate: When to consider imaging tests: They re necessary in certain instances If the patient has an abnormal result in a medical exam. If the patient has head pain that is sudden, explosive and different from pain in the past and is accompanied by a fever, change in vision or speech. If pain worsens, then it may signal damaged cartilage, broken bones, or torn muscle tissue. An X-ray or MRI may be in order. All eligible IEHP physicians who provide preventive and diagnostic care and treatment to IEHP adolescent Members under the P4P program:* Member must be active on the date of service. Physicians are reimbursed directly by IEHP through P4P. Data submissions must be done electronically through the IEHP website, iehp.org. * PCPs and OB Specialists are automatically enrolled in P4P upon completion of IEHP s credentialing process, designation of an effective date for participation in the IEHP network and initial provider in-service completion. Exam determine the location and degree of pain. Start with non-narcotic drugs (over the counter meds like Tylenol, Ibuprofen or Aleve) when possible. Try basic therapeutic techniques. Refer to physical therapy (PT) the non-drug method. Consider alert symptoms: Ongoing pain symptoms lasting for many months. Restricted range of motion that is not getting better with PT treatment or OTC meds. Pain continues whether the patient is still or moving. In severe cases (for ongoing, chronic pain lasting many months), stronger pain meds may be recommended. For details on our P4P Program, visit iehp.org or call Provider Relations at (909) 890-2054. 2 $25 per test, up to 4 payments per Member/year $50 per HbA1c test result (less than 8.0, up to one payment per Member/year) $25 per test, only one payment per Member/year $25 per exam, only one payment per Member/year * IEHP will not be reinstituting the LDL payments. We are also changing the HbA1c level for bonus payment for test results of less than 8.0 (formerly 7.0 or less). Where to refer Family Care Center (Riverside) Ages 20 45 years: Wellness Exam (plus routine tests named above) Screening for chlamydia, for sexually active women (25 and below) Cholesterol screening (men 35+ and women 45+ with known risk factors for coronary heart disease) Symptoms of conditions like asthma, diabetes, high blood pressure $40 for Well-Child Visits (birth - 7th birthday) HbA1c Testing HbA1c Control Bonus Microalbumin Test Diabetic Retinal Exam Vaccine or Ages 11 18: Adolescent Well-Child Exam (plus routine tests named above) General health and wellness (meals, exercise, weight and sexual well-being) Vaccines needed Symptoms of conditions like asthma, pre-diabetes, high blood pressure Development and behavior Preventing injury Signs of mental illness (e.g., major depression, phobias, and obsessive behaviors encourage screenings to prevent bad outcomes ) $100 for Non-Direct Medicare PCPs (adults) Starting New Year s Day, IEHP restores and increases its incentives for the following programs: (Note: Physicians can earn up to $200 per Member/year for total compliance with the program.) Physicians are responsible for providing recommended immunizations to Members. If you have difficulties getting the vaccines listed below, you may direct Members to go to the alternative sites shown: For every Member, IEHP covers routine tests: Blood pressure testing BMI measurement Complete blood panel, if needed Height and weight Oral/dental health (pre-screen) Simple hearing and vision tests Urine testing, when appropriate $200 for Direct Medicare PCPs (adults) Diabetes P4P Program Returns Getting shots to prevent disease is not only for school-kids. It s also for adults from 15 years through middle-age to seniors 65+. Encourage your adult patients to maintain their health by getting recommended shots. Throughout an adult s life, he or she will need vaccines to protect against anything from the shingles to pertussis to pneumonia. What IEHP covers in the Annual Visit P4P incentives for annual exams : Where Can Your Adult Patients Get Them? 3 Be sure to perform careful reassessments if you find that ongoing treatment is needed. A systematic and ongoing treatment plan helps to move your patient s care in a positive direction. 4