Mount Sinai Health Partners
Clinically Integrated Network Newsletter
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In episode 12 of the MSHP podcast, Stephen Furia, Senior Vice President of Population Health Solutions for Mount Sinai Health System, joins Dr. Fields to discuss the demand side of the healthcare system. Using the example of Walmart’s Centers of Excellence, they discuss how large employers are beginning to emphasize value in their employee health plans and what this means for the healthcare consumer market going forward.
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Mike Berger, Vice President of Population Health Informatics and Data Science for the Mount Sinai Health System, joins Dr. Fields in this episode to discuss data and population health. Mike Berger explains what it means to treat data as an asset – not just valuing data and hoping we have enough to make decisions, but investing time and technology in it to create feedback loops which can then be built into future models.
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In the tenth episode of the MSHP podcast series, Maria Alexander, MSHP’s Senior Director of Clinical Operations and Government Channels, and Dr. Fields discuss CMS and healthcare delivery systems working on population health. They ask how health systems change incentives so providers can think of care more holistically for all the patients they serve, getting things done in big and bureaucratic organizations, the movement toward quality, and more.
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Please review the 2019 Clinical Integration Program Timeline Checklist with deadlines for all the 2019 CI Program Participation Requirements (
for PCPs
) (
for Specialists
).
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2019 Clinical Integration Program
Similar to previous years, primary care providers (PCPs) and specialists will have to complete their
Clinical Integration Program Participation requirements
in 2019 (
PCPs
) (
Specialists
). The
Quality Performance Metrics
remains as another component of the Cl Program but one new program element for PCPs, the
Efficiency Performance Metrics
is introduced in 2019. These three components will impact the overall calculation of a PCP’s individual clinical integration index, which will dictate your individual incentive payment. As a reminder, as a PCP you must complete the six participation requirements (Tier 1 and Tier 2) to continue CIN participation. For specialists, the quality reporting process changes slightly.
For PCPs:
- CI Participation Requirements: PCPs must complete the requirements under Tier 1 by the established deadlines in order to receive quarterly base payments. PCPs must complete the required Tier 2 element by the end of 2019 in order to be eligible for an annual incentive payment. Deadlines for each of these requirements are outlined in this 2019 Clinical Integration Program Requirements Timeline Checklist for PCPs.
- Quality Performance Metrics: This year, PCPs will need to report on the following six mandatory quality measures and will have the opportunity to earn additional points for each individual quality measure reported based on established benchmark. This process will be managed through our new online platform, ADSP, which is run by our partner, Lumeris. More information will be available in a few weeks.
- Efficiency Performance Metrics: There will be two mandatory metrics and providers will not need to report data on this. MSHP will assess performance on these metrics based on claims data.
Successful completion of these requirements and metrics will impact your 2019 quarterly base care coordination payments and annual incentive payment.
There are assigned points to these requirements and metrics, which impacts your Clinical Integration Index Score and that ultimately determines your 2019 annual incentive payment. Log in to the MSHP website and then
click here
to read the 2019 Clinical Integration Program and PCP Funds Flow Program Reference Guide to learn more.
For Specialists:
- Quality Performance Metrics: Specialists will only be asked to report on their quality metrics biannually, instead of quarterly. These metrics can be found here. The first biannual submission will be due 7/12/2019 and the second biannual submission will be due 1/17/2020. Quality reporting will again be completed through Box.com.
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HIPAA Education Program 2019
The 2019 HIPAA compliance module is now available in the Clinical Integration Learning Center (CILC). This online course explains the business and regulatory reasons for complying with HIPAA Privacy and Security regulations and includes examples that address common risks and challenges.
Completion of this requirement is due by the end of quarter 3 for both PCPs and Specialists
.
To access the course,
log in to CILC
, click on "Learning Events," select "Compliance" under Categories. On the Compliance page you should then see the below course:
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Provider Spotlight:
Dr. Margaret Kearns-Stanley, Family Physician
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We sat down with Dr. Margaret Kearns-Stanley, a family medicine physician on the Upper East Side to discuss her journey as a physician, her passion for family medicine, and how treating people as individuals with an understanding of their culture is critical for keeping them healthy. As an 8-year old, Dr. Kearns-Stanley’s grandmother was diagnosed with lung cancer and it was that experience that led her to the pre-med track as an undergrad. But she says it was the time she spent in Oakland that really shaped her career and her approach to medicine.
Read more
.
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Review the 2019 CI Program requirements in our Q4 Voluntary Town Hall recording, available in CILC. This segment starts at 14:45. To access,
log in to CILC
and click “Learning Events” and “Voluntary Town Hall.”
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Important Notice for Behavioral Health Providers
This notice is for behavioral health providers treating patients in Mount Sinai Health’s System’s Employee Health Benefit Plan Administered by UMR, a division of UnitedHealthcare. When issuing Behavioral Health/Substance Abuse notifications where no medical necessity documentation is required, please fax UMR the clinical note and indicate that it is for pre-notification only. No special form is required. Please ensure you do the following:
- Indicate that the notification is for a domestic facility (Mount Sinai facility, if applicable)
- Indicate that it is a “Pre-Note only” (pre-notification)
- Fax these notifications to UMR at 866-494-4502
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1199SEIU Update on Copays
Your 1199SEIU Greater New York Benefit Fund patients will no longer have co-payments for the following services:
- Primary care physician and specialty visits
- CT scan, PET scan, MRI, MRA, and other high-end radiology services
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Our Agreement with Oscar
Mount Sinai has an Agreement with Oscar
to provide the best possible care for New Y
orkers
. As an in-network provider, you can now see Oscar members in the Circle and Circle Plus networks.
The Oscar Circle network includes providers from Mount Sinai, Montefiore, Catholic Health Services of Long Island and New Jersey QualCare Network.
The Oscar Circle Plus network is our most comprehensive network and provides small businesses access to National Coverage, Northwell, Memorial Sloan Kettering, and Westmed in addition to all of our Circle providers. You can find an overview of the Circle and Circle Plus networks
here
.
Please note,
Oscar members may have different network coverages. To ensure proper reimbursement, be sure to check eligibility for all Oscar members on their
Provider portal or by calling 855-672-2755.
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Bright Health Webinars Available on Availity
Missed the Bright Health webinars or want to review the information presented?
You can now access the slides and recordings by going to
www.availity.com
and signing in. Then click on “Payer Spaces” on the top header and choose the Bright Health Plan Icon which will take you to the Resources Page. From there the Provider Webinar is listed first. To access, click on “Bright Health Provider Webinar.”
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Efficiency Performance Metrics & Preventable ED Visits
In 2019, primary care providers will participate in the CIN Efficiency Performance Metrics (EPM) program by working to reduce preventable ED visits and inpatient admissions for their attributed panel of patients. While CIN providers have previously received information about preventable ED visits, preventable inpatient admissions are hospital admissions with Ambulatory Care Sensitive Conditions (ACSCs), part of the Prevention Quality Indicators (PQIs). PQIs measure potentially avoidable hospitalizations among various disease states, including diabetes, COPD, asthma, heart failure, hypertension, and others. MSHP will provide additional information for providers and practices during the upcoming engagement meetings. For more information about PQI and ACSC definitions, please
click here.
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Population Health in the Literature & Media
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Questions around Medicare’s Hospital Readmissions Reduction Program
Two recent articles have called into question the policy implications around Medicare’s Hospital Readmissions Reduction Program (HRRP). An article published in JAMA found an association between the implementation of the HRRP and increased 30-day post-discharge mortality. A separate article, published in Health Affairs, found that readmission reductions may have been overstated due to simultaneous changes in electronic transaction standards that allowed more diagnoses to be documented per claim. Read the findings from
JAMA here
and the findings from
Health Affairs here
.
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Medicare quality reporting season is here!
Did you know?
Annually, Medicare Advantage plans are responsible for submitting quality data to the Center for Medicare and Medicaid Services (CMS). Health plans then receive a Star Rating which represents their overall quality score in comparison to national benchmarks and peers. Health plans may request that you submit your quality data to them for CMS reporting. Similarly if you participate in a Medicare ACO, your ACO may be submitting data on your behalf. For more information about Star Ratings, visit
the CMS site.
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P: 877-234-6667
F: 212-523-5775
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