PROVIDER NEWSLETTER Spring 2016 IN THIS ISSUE: Recover Wellness Program Overview Integrated Care Success Stories HEDIS Measures Respite Care Policy Updates Health Choice Integrated Care Becomes the Regional Behavioral Health Authority in Northern Arizona On October 1, 2015, Health Choice Integrated Care (HCIC) became the Regional Behavioral Health Authority (RBHA) for Northern Arizona. The Arizona Department of Health Services (ADHS) and Arizona Health Care Cost Containment System (AHCCCS) designated HCIC to be the managed care organization responsible for the planning, implementation, funding, monitoring and administration of publicly funded comprehensive behavioral health and crisis services to Title XIX eligible (Medicaid) children and adults, and non-txix adults who qualify as Seriously Mentally Ill (SMI), with behavioral health or substance use disorders. HCIC is also an Integrated RBHA, functioning as the AHCCCS Health Plan for Title XIX eligible people who qualify as Seriously Mentally Ill (SMI). The HCIC Northern Arizona Geographic Services Area includes Mohave, Yavapai, Coconino, Navajo, Apache, and Gila counties. Despite the expansive geographic footprint of our service area, HCIC has established a full continuum of covered physical health and behavioral health services to meet members needs.
AHCCCS Stresses State-Wide Behavioral Health Service Timeliness AHCCCS has started a state-wide campaign on Twitter, #Nowaitlists, to convey the State of Arizona's strong stance that it is not acceptable for eligible members seeking behavioral health services to be placed on wait lists." If this problem occurs, individuals or families are being encouraged to report the problem immediately to the RBHAs or health plans. In general, these are the required statewide time frames for response to a service request: immediate/crisis need within 2 hours; urgent need within 24 hours; and routine within 7 days. For our region, members can call HCIC Member Services number at 1-800-640-2123. If members in any AHCCCS plan are being placed on wait lists for services, they can report the problem to us or AHCCCS and we will aggressively make sure that services are offered and that the wait list is abolished. There should be no wait list for AHCCCS members. Shawn Nau, HCIC Chief Executive Officer Recover Wellness Program Recover Wellness is a Health Choice Integrated Care program for members living with serious mental illness. The program is a comprehensive integrated care model which builds on our Health Home (HH) model and defines six clear goals for achieving effective and efficient models of care for our members based on best practices to achieve the Institute for Healthcare Improvement (IHI) Triple Aim of improving the experience of care, improving the health of pop-ulations and reducing the per capita cost of health care. HCIC Integrated Care Managers also provide care management/care coordination to our highest-risk, highestcost members through identifying gaps in services and coordinating critical health information to primary care and behavioral health providers. Recover Wellness aligns with the Affordable Care Act s Six National Quality Strategy s Priorities and has demonstrated outcomes by: Making care safer by reducing harm caused in the delivery of care Ensuring each person and family is engaged as partners in their care through timely care, member choice and culturally appropriate services Promoting effective communication and coordination of care Promoting the most effective prevention and treatment practices for the leading causes of mortality Working with communities to promote best practices for healthy living Making quality care more affordable by developing and spreading new health care delivery models. Integrated Care Brings Success to Members HCIC is happy to report that our team has seen many successes in the Recover Wellness program, which integrates behavioral health and acute health care at the integrated RBHA level. To name a couple: Through our Maternal Health program, three high-risk pregnant members with SMI who weren t in behavioral health services have agreed to start receiving behavioral health services. One member, who had previously lost custody of her other children, and in partnership with the Department of Child Safety, was able to keep her baby and has accepted wraparound services at Spectrum Health Group (Yavapai County) for the next six months to ensure important mother-infant bonding and to treat her depression. A 57-year-old member with SMI and multiple medical conditions including COPD, CHF, and Bipolar Disorder recently received a new Integrated Care Management Plan developed by her HCIC Integrated Care Manager. The Care Manager was able to coordinate her care across all of her providers, and to identify risk factors that were unknown to some of her healthcare providers. Since then, the member has had no recent hospitalizations, meets with a health coach regularly at her PCP office, and has improved her usage of oxygen and medications.
Health Risk Assessments (HRA) Parent Support NOW Pilot Project Parent Support NOW is a program that supports parent-to-parent connections via education and assistance with navigating the various systems families may interact with upon involvement with the Department of Child Safety (DCS). Parent Support NOW aims to provide immediate assistance to families of origin when their child(ren) have had a DCS emergency custodial removal. Parent Support NOW provides family support to the family of origin throughout the continuum of DCS involvement with the goal to engage families in necessary behavioral health or substance use services and to reunite families as quickly and appropriately as possible. Parent Support NOW is a pilot project developed through collaboration with HCIC, DCS, Mohave County Superior Court, Mentally Ill Kids in Distress (MIKID), Mohave Mental Health Center, and Southwest Behavioral Health Services in Kingman, Arizona. In order to ensure prompt and complete delivery of services for our members, HCIC relies on our Integrated Health Homes (IHHs) as partners in collecting Health Risk Assessments (HRAS) for all HCIC members in the Recover Wellness program (T19 SMI Integrated RBHA). HRAs are surveys of health behaviors and risks that are completed by the member. As part of the contractual requirements, all IHH s are required to collect an HRA for SMI members initially at intake, and then annually thereafter. The HRA is then submitted to HCIC for review and consideration in the development of high risk member Integrated Care Management Plans. This component of our delivery system is critical in the screening process for SMI members in order to appropriately assess care needs, and facilitate coordination of care and services with the member s PCP. If you have any questions regarding the HCIC HRA process, and/ or are in need of more information regarding the completion and submission or HRAs, please contact Jennie McMillian, HCIC Chief Clinical Officer, at 928-774-7128 or by email at Jennie. McMillian@iasishealthcare.com for assistance. PROVIDER SPOTLIGHT MIKID is a non-profit, licensed outpatient clinic, family-run organization in the State of Arizona and contracts with all Regional Behavioral Health Authorities (RBHAs) to provide behavioral health services to youth and families throughout Arizona. MIKID provides support, education, and skills development to families and their children as well as youth and young adults who are experiencing mental health and behavior challenges throughout Arizona. To find out more visit www.mikid.org
Respite Care Respite is a covered behavioral health service that allows the parent or caregiver a period of rest or relief from their caregiving responsibilities. Respite can be a key strategy to strengthen and support a family with a high-need or a special needs child and can help prevent out-of-home placements. Licensing Rule Changes in 2014 In 2014 changes were made to the respite care licensing rule that prohibited Community Service Agencies from providing respite care; which in turn, significantly limited and restricted families access to respite services. Outpatient Treatment Centers (OTC) were also included in this prohibition of providing respite care. HCIC Advocacy Grants Easier Access to Respite Care Through Health Choice Integrated Care s advocacy activities, licensing rules related to respite are being amended, which will grant easier access to respite services for families across Arizona later this year. As a result of state legislation passed in 2015, and our active involvement in the licensing rule process at the Arizona Department of Health Services, there will be revisions to A.A.C. R9-10-Article 7, Behavioral Health Residential Facility (BHRF) licensing rules and a new service, Respite Services for Children on the Premises will be added to the Outpatient Treatment Center (OTC) rules. Both of these changes will take effect this summer. The portion of the BHRF licensing rules related to respite, R9-10-707, will be amended to specify that a medical history and physical examination is not required for a child admitted for residential placement who is expected to stay at the facility for less than ten days in a 90 consecutive day period. The OTC licensing rules will have a specific service for, Respite Services for Children on the Premises. The requirements for this service are similar to those of licensed child care facilities. A provider of an OTC that wishes to deliver this service will need to send a letter to the Department of Health Services, Division of Licensing Services, requesting authorization to deliver this service. To view the draft rules and/or provide the Department of Health Services with input into those rules, please go to: http://www.azdhs.gov/ops/oacr/ rules/rulemakings/active/index.php and select co-location/respite rules. If you have questions about delivering respite in your community, please contact Laura Hartgroves, Network Development & Advocacy Administrator, at Laura.Hartgroves@iasishealthcare.com.
Frequency Schedule Well Screening for 18-20 year-olds Health Choice Integrated Care needs providers to help us assess the health and well-being of 18-20 year olds who are in the Recover Wellness plan as part of the AHCCCS Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Our dedicated EPSDT Coordinator, Jackie Smart,RN, will help identify those specific members and then supply the EPSDT tracking form to providers. The form is also on the AHCCCS website at https://www. azahcccs.gov/shared/downloads/medicalpolicymanual/appendixb.pdf. This form helps us collect data for analysis and compliance with the program. Here s how you as a provider can utilize the program: INTEGRATED HEALTH HOMES Make EPSDT visits a part of the Adult Recovery Team (ART) discussion and include the EPSDT visit as a part of the Integrated Recovery Plan (IRP). Encourage and assist 18-20 year-old members to receive their annual EPSDT services: physical, dental, vision, and hearing. Provide follow up for missed appointments. Consult the HCIC EPSDT Coordinator when applicable for Care Management. Encourage the 18-20 year-olds to receive their primary care at the Integrated Care Clinics. For HCIC Members designated SMI and between 18-20 years old, well visits are required annually. HCIC requires providers of EPSDT services to utilize the AHCCCS approved standard developmental screening tool, or an electronic equivalent, for this age group. HCIC provides education and assistance to providers to ensure utilization of the most current approved EPSDT forms. These forms are available on the AHCCCS website at https://www. azahcccs.gov/shared/downloads/ MedicalPolicyManual/AppendixB.pdf. EPSDT E P S D T Early: start well health visits early Periodic: be seen annually Screening: screen for behavioral and physical health issues Diagnosis: obtain relevant diagnosis Treatment: develop a patientcentered treatment plan PRIMARY CARE PHYSICIANS Utilize the 18-20 year-old EPSDT tracking form annually to evaluate the medical and behavioral health needs of the member, making appropriate referrals to medical, behavioral, dental, vision, hearing, and community resources. Send a copy of the tracking form to HCIC EPSDT Coordinator for data collection purposes and monitoring of referrals. P rovide follow up for missed appointments. For more information regarding EPSDT forms, please contact Jackie Smart, MH/EDPST Coordinator, at Jackie.Smart@iasishealthcare.com
HEDIS Measures The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) that is being utilized by AHCCCS for all AHCCCS Health Plans, including HCIC. Each health plan is responsible for the timeliness and quality of health care services (acute, preventative, behavioral health, etc.) delivered to our diverse membership. State purchasers of health care use the aggregated HEDIS rates to evaluate the effectiveness of a health insurance company s ability to demonstrate an improvement in preventive health outreach to its members. As both state and federal governments move toward a health care industry driven by quality, HEDIS rates are becoming more and more important, not only to the health plan, but to the individual Provider as well. Physician-specific scores are being used as evidence of preventive care from primary care office practices. These rates then may serve as a basis for physician profiling and incentive programs. SMI Integrated HEDIS Performance Metrics DIABETIC CARE: HBA1C TESTING BREAST CANCER SCREENING Age: 18-75 Age: 42-69 Frequency: Every year Frequency: Every 2 years Description: Continuously enrolled members with diabetes who had at least one HbA1c test in the measurement period. MPS: 77% MPS: 50% DIABETIC CARE: EYE EXAM DIABETIC CARE: LDL-C SCREENING women who received a mammogram to screen for breast cancer during the measurement period FLU SHOTS Age: 18-75 Age: 18-64 Frequency: Every year Frequency: Every year Description: Continuously enrolled members with diabetes who had LDL-C screening during the measurement period. CERVICAL CANCER SCREENING Age: 18-75 Age: 21-64 Frequency: Every year Frequency: Every 3 years Description: Continuously enrolled members with diabetes who had an eye exam for diabetic retinal disease during the measurement period. MPS: 49% MPS: 64% MPS: MPS: 75% Description: : Number of women who received one or more cervical cytology for cervical cancer during the measurement period members who had an influenza vaccination during the measurement period. CHLAMYDIA SCREENING IN WOMEN Age: 16-24 Age: 18-64 Frequency: Every year Frequency: women that were identified as sexually active and that had at least one test for Chlamydia during the measurement period. MPS: 63% MPS: 86% ADULT PREVENTATIVE CARE USE OF APPROPRIATE MEDICATIONS FOR ASTHMA Description: Members 18 through 64 years of age who were identified as having persistent asthma and were dispensed appropriate medications during the measurement period. TIMELINESS OF PRENATAL CARE Age: 20+ Age: 18-64 Frequency: Every year Frequency: visit in the first trimester (176 to 280 days prior to delivery or EDD) or within 42 days of enrollment (for women with a gap in enrollment, the last enrollment segment during the pregnancy is the enrollment start date) members aged 20+ who had a preventive care visit during the measurement period. MPS: 75% MPS: 80% Mean Performance Standard (MPS) women who had live deliveries during the measurement period and who received a prenatal care.
Prior Authorizations Performance Measures: Follow-up after Hospitalizations It is required to provide outpatient follow-up services after hospitalization to ensure that a member s transition to the home environment is wellcoordinated. Unnecessary hospital readmissions can be avoided by ensuring the member is supported during discharge planning, and also after they leave the hospital. Every member that is hospitalized should receive a followup appointment with a physician or behavioral health medical provider within 7 days of discharge. New E-Prescribe Performance Improvement Project Health Choice Integrated Care is participating in the AHCCCS-driven Performance Improvement Project (PIP) for e-prescriptions. The purpose of this PIP is to increase the number of prescribers electronically prescribing prescriptions and to increase the percentage of prescriptions which are submitted electronically in order to improve patient safety. In the next few months, network representatives will be outreaching to top providers who are not electronically prescribing. If you have any questions about the PIP, please contact Stephanie Earl, HCIC Pharmacy Director, at 928-774-7128 or Stephanie.Earl@iasishealthcare.com At HCIC, our goal is to work closely with you and your practice team to streamline and expedite prior authorization through a centralized prior authorization call center shared with Health Choice Arizona. Many of the items on our abbreviated prior authorization list ask for notification only. Requests for services that require prior authorization can be submitted on the HCIC Prior Authorization form by fax or requests can be phoned into the HCIC Prior Authorizations department by calling Health Choice Arizona 800-322-8670-- Option 4 (HCA Provider) then Option 1 (Medical PA). All requests must include complete diagnosis and procedure codes, and the accompanying medical documentation (as needed). For forms, fax or phone numbers please visit www.healthchoiceintegratedcare.com under Providers. HCIC Health Care Buddy Program As part of HCIC s ongoing effort to engage 18-20 year old members with SMI in need of EPSDT services and other high risk members with SMI, HCIC has established a new Buddy Program, specifically designed to facilitate outreach and access to needed care and services. Outreach efforts focus on identifying these members who are at especially pivotal or critical transition points such as recent discharges from the hospital, recent or frequent visits to the emergency room, not beeing seen for an extended period of time, or recently contacing HCIC regarding a question or complaint about their care or services. If you would like more information about HCIC s Buddy Program, or have identified a member you believe could benefit from this program, please contact HCIC Member Services.
24/7 Nurse Advice Line Remember, Health Choice Integrated Care offers a 24/7 Nurse Advice Line for our members, providing the peace of mind that medical questions can be answered at any time. Imagine waking up in the middle of the night with a headache or dizziness. For some people, that may cause a little panic. Dialing the 24/7 Nurse Advice Line instead will allow members to speak with someone about their medication and discuss symptoms. Call anytime at: 800-322-8670 l TTY 711, 24 hours a day, 7 days a week. We are ALWAYS happy to help you. Crisis Response Network Line Our 24/7 Crisis Response Network for behavioral health crisis is available to anyone of any age and is free of charge. Spanish speaking crisis specialists and interpreters are also available 24/7. Central Arizona Crisis Line: 800-631-1314 TTY: 800-327-9254 Northern Arizona Crisis Line: 877-756-4090 Central Arizona Warm Line: 602-347-1100 www.crisisnetwork.org Anxious STRESSED ANGRY MAD Hopeless STRESSED ANXIOUS Frustrated hopeless ANGRY Anxious PREOCCUPIED FIXATED Worried PREOCCUPIED MAD Confused Trapped Confused Afraid Lonely Frustrated FIXATED Depressed MAD lonely Member Handbooks Is your facility in need of handbooks? Please contact our Communications Manager, Sierra Gadberry, at 928-774-7128 or by email at SGadberry@ iasishealthcare.com to arrange a pickup at our office in Flagstaff. 2015-2016 Member Handbook HealthChoiceIntegratedCare.com Care with a Conscience CALL FOR PROVIDER DIRECTORY UPDATES Has any of your information changed? We like to keep our records up to date. Please contact Mindy Adler, HCIC Network Management Administrator, at 928-774-7128 or by email at Mindy.Adler@iasishealthcare. com if you have changes to your roster, address, and fax or phone number.