February 12, 2019
Mount Sinai Health Partners
Clinically Integrated Network Newsletter
Podcasts

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.  

Also available through  iTunes  and  Google Play

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.

Also available through  iTunes  and  Google Play

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. 

Also available through  iTunes  and  Google Play
Provider Spotlight:
Dr. Margaret Kearns-Stanley, Family Physician
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

If you’re interested in being featured, please contact tiffany.cheng@mountsinai.org
Payer Updates
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
 
Click here for the UMR member lookup guide. 
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
 
Please click here for more information.
Our Agreement with Oscar

Mount Sinai has an Agreement with Oscar t o 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.
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.”
Value & Efficiency
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
Population Health in the Literature & Media
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
Quality Corner
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.
If you have any questions about any of our announcements, please contact your Provider Engagement Manager , email Mount Sinai Health Partners at mshp@mountsinai.org or call us at 877-234-6667.  
Contact Us
P: 877-234-6667
F: 212-523-5775