Mount Sinai Health Partners
Clinically Integrated Network Newsletter
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Episodes 2 and 3 on Population Health and Care Management
Each month, we will feature at least one member from our senior leadership team to talk to you about a range of topics including policy and health care news to updates about clinical programs. E-mail us at
mshp@mountsinai.org
if you are interested in hearing about a specific topic.
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How does the complex relationship between physician, patients, and health plans create an environment where traditional laws of supply and demand don’t apply? And what does that mean for population health? According to Niyum Gandhi, Executive Vice President and Chief Population Health Officer at Mount Sinai Health System, this is an opportunity to own the problem and solve it by transforming care delivery into a model where both patients and providers benefit from positive outcomes and preventive medicine.
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MSHP’s Senior Director of Care Management, Maria Basso Lipani, LCSW, discusses the Mount Sinai approach to care management, different from case management, in its broad approach to understanding readmission risks and helping patients solve problems by understanding their deeper causes. This approach is based on the principles that the highest-risk patients can be reached, patient engagement is critical, and community collaboration is fundamental.
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September 28th Deadline: Your Mandatory CIN Requirements
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CIN providers must complete these requirements in order to stay in the CIN. Primary Care Providers need to complete these requirements by September 28th to continue to receive care coordination payments.
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Privacy Training Requirement Due September 28th
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Your Program Education Requirement is Due September 28th
You can fulfill the Program Education requirement by attending the
September 25th Town Hall.
If you’re unable to join us this time, please watch our past town hall videos by clicking on any of the links below.
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MSHP Q1 2018 Voluntary Town Hall
Topics include utilization optimization, pharmacy quality and utilization priorities, usage of skilled nursing facilities for patients, and an update on Provider Insights.
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MSHP Q2 2018 Voluntary Town Hall -
Topics include a highlight on Provider Insights and a strategic update from our new Chief Medical Officer, Dr. Robert Fields.
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Monday, September 17, 2018:
Deadline for 2018 Annual Dues
Friday, September 28, 2018:
CI Program Education Requirement Due
Friday, September 28, 2018:
CI Program Privacy Training Requirement Due
Friday, October 12, 2018:
Q3 2018 Quality Reporting Due
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Deadline Approaching: Your 2018 MSHP Annual Membership Dues
On Monday, August 6, you should have received a reminder e-mail from Mount Sinai Health Partners regarding your 2018 MSHP annual dues.
The deadline is Monday, September 17, 2018. Annual membership dues are for the calendar year and vary depending on provider type and network participation. Please note that dues for primary care providers are waived.
Please refer to that email for details on how much your practice should pay. You can also learn more by visiting our Pay Dues page after you log into
https://mshp.mountsinai.org/.
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Fulfill a Clinical Integration Program Requirement: Attend the Q3 2018 Town Hall on Tuesday, September 25
Join us on Tuesday, September 25th from 6:30 – 8:00pm at 150 East 42nd Street for the
Q3 2018 Town Hall.
Learn how MSHP is engaging with Lumeris to support patient care and identify improvement opportunities. Also, learn more about Healthix and receive an update on MSHP's care management strategy.
Please register by Friday, September 21st by
clicking here, emailing us at
MSHP@mountsinai.org, or calling at 1-877-234-6667. You may attend in-person or via webinar.
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Waived Fees and Up to $13,000 in Incentives Available to Eligible Practices by Connecting to Healthix
Mount Sinai Health Partners providers are encouraged to participate with Healthix, a health information exchange (HIE) that is connected to hundreds of health care providers across New York City and Long Island. Being connected to other providers gives you access to more data about your patients, especially at the point of care, and you’ll receive clinical event notifications, and greater insights to help manage patient risks.
Providers who sign a participating agreement with Healthix before September 30, 2018 will have their HIE connection fees waived. Additionally, you may be eligible to receive up to $13,000 from the New York State Department of Health (NYSDOH) to help offset the costs involved with HIE adoption.
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Getting Patients to Consent to Data Sharing
It is important to inform your patients that sharing their medical information is secure and is limited only to the healthcare providers involved in their care and the organizations that the patient chooses to give their consent to. Be sure to share this information at the front desk or speak with your patients about this important initiative.
Key Points to Emphasize When Discussing Healthix Consent with Your Patients:
- Faster, informed, and appropriate decisions are possible with Healthix. In case of an emergency, all attending clinicians will have access to the data they need to make the right medical decisions on your behalf.
- You will receive safer and more efficient care. With a comprehensive view of your medical history including lab results and allergies, Healthix reduces repeated tests and minimizes the possibilities of adverse drug affects.
- A variety of consent options keep you in control of your information and who can access it. You may also withdraw consent at any time.
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Population Health in the Literature
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Changes in Health Care Costs and Mortality Associated With Transitional Care Management Services After a Discharge Among Medicare Beneficiaries
An observational study of over 18 million Medicare discharges examined the association of transitional care management services (TCM), identified through TCM billing codes, with post-discharge outcomes. Seven percent of eligible patients had TCM codes billed following discharge in 2015. These patients had lower rates of mortality and lower total cost of care compared to patients who did not receive TCM billed services.
Check out the article in JAMA Internal Medicine
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What are transitional care management (TCM) services?
TCM, as defined by CMS, are services rendered post-discharge that help reduce medication errors and promote safe transitions out of the hospital. They include both telephonic outreach and face-to-face encounters. TCM services are eligible for enhanced reimbursement from Medicare, Medicare Advantage, Medicaid and Commercial payers.
Learn more.
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Changes to Aetna’s National Precertification List
There have been recent changes to Aetna’s National Precertification List. Please submit precertification requests at least two weeks before the scheduled services. For more information, please
download this guide and
visit this site.
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Changes to Empire’s Precertification Requirements
Beginning with dates of service from November 1, 2018, Empire will expand precertification requirements to include upper gastrointestinal (GI) endoscopy, also referred to as esophagogastroduodenoscopy (EGD) for local fully insured commercial members. AIM Specialty Health (AIM), an Anthem owned subsidiary, will administer this EGD review on behalf of Anthem. For more information,
click here.
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P: 877-234-6667
F: 212-523-5775
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