www.MercyCareAZ.org
Summer 2018
The Mercy Care Quarterly Provider Newsletter contains valuable and important information for our providers and community partners that can be used to help provide the best possible care for our members.  The Provider Newsletter covers all Mercy Care lines of business, including Mercy Care Complete Care, Mercy Care Long Term Care, Mercy Care RBHA, Division of Developmental Disabilities and Mercy Care Advantage. 
Cover Story

Welcome to Mercy Care! 
Welcome to Mercy Care! Effective July 1, 2018, Mercy Care Plan merged with Mercy Maricopa Integrated Care into one company, Mercy Care. Mercy Care includes the following lines of business:
  • Mercy Care Complete Care
  • Mercy Care Long Term Care
  • Developmental Disabilities
  • Mercy Care RBHA
  • Mercy Care Advantage

The following changes have been made to accommodate this merger: 
  • New website landing page - Our new URL www.MercyCareAZ.org is now live. This new landing page will direct providers to the appropriate websites and pages for each Mercy Care line of business. It provides a quick way to toggle back and forth between different lines of business.
  • All Mercy Care internal e-mail addresses have been updated to include our new URL.
  • Provider Manuals have been updated with new naming conventions and logos. A new notification containing all changes to the Provider Manual was sent on 7/2/18.

New social media channels are also now available. You can follow us on Instagram, LinkedIn and YouTube. Just foll ow the links below:
 

We will provide you with additional information as we prepare for our upcoming AHCCCS Complete Care (ACC) award on Oct ober 1, 2018 through provider notifications and in our Fall 2018 Provider Newsletter. 
We pledge to continue to provide outstanding service to our provider partners.

All Plans Corner

Blood Pressure – the way you check can increase the reading
Did you know?
Some common practices used when taking a blood pressure can raise BP readings artificially, for example:
  • Putting a blood pressure cuff over clothing, instead of a bare arm, can add between 5-50 mmHg to systolic BP.
  • Having a conversation can add up to 10mmHg to systolic BP.
  • Not supporting the arm at heart level can add up to 7 mmHg to systolic BP.
  • Sitting with the back unsupported can add 6-10 mmHg to systolic BP.

What can you do to help your staff take an accurate Blood Pressure measure? 

Review these simple guidelines with your staff:
  • Encourage the patient to sit:
  • with their back and feet supported
  • with their legs uncrossed
  • with their arm supported at the level of their heart
  • Wait at least 5 minutes after arrival in the office to measure blood pressure.
  • Apply the blood pressure cuff over bare arm.
  • Stop all conversation during blood pressure measurement.
  • Take a minimum of two blood pressures.
 
Sources:
Joel Handler, The Importance of Accurate Blood Pressure Measurement . Perm J. 2009 Summer; 13(3): 51–54.
Pickering, et al., Recommendations for Blood Pressure Measurement in Humans & Experimental Animals: Part 1: Blood Pressure Measurement in Humans: A Statement for Professionals from the Subcommitee of Professional & Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005; 11(5): 697-716.

Claims Addresses
It’s very important to direct your claims to the appropriate P.O. Box in order to avoid uncertain delays in claims payment. We encourage you to submit your claims electronically however if you need to submit a paper claim, it should be submitted as follows: 

MEDICAL CLAIMS
  For: Mercy Care Complete Care
          Mercy Care Long Term Care
          Mercy Care Advantage
  Attention: Claims Department
  P.O. Box 52089
  Phoenix, AZ 85072-2089                                                                        
  
For: Mercy Care RBHA
  Attention: Claims Department
  P.O. Box 64835
  Phoenix, AZ 85082-4835

DENTAL CLAIMS
   For: Mercy Care Complete Care
          Mercy Care Long Term Care

  DentaQuest of Arizona, LLC
  Attention: Claims
   12121 N Corp Parkway
  Mequon, WI 53092

   For:  Mercy Care Advantage
   Attention:  Dental Claims Department
    P. O. Box 61235
   P hoenix, AZ 85082-1235
  For: Mercy Care RBHA
   Attention:  Dental Claims Department
   P.O. Box 62978
   Phoenix, AZ 85082-2978

REFUNDS
   For: Mercy Care Complete Care
            Mercy Care Long Term Care
            Mercy Care Advantage
            Mercy Care RBHA
  Attention: Finance Department
  P.O. Box 90640
  Phoenix, AZ 85066

Partnership and promise: Improving the health of a community
A news article regarding the NORC Study was posted to our website regarding three research studies of programs and services offered by Mercy Care RBHA to address social determinants of health. The results found some components of the programs can reduce cost and improve quality of care for people with serious mental illness. 
Supporting people with serious mental illness designations to address the social determinants of health - stable housing, employment, food security - has a positive impact on their path to recovery. See how Mercy Care RBHA does this every day with the results from research conducted by NORC at the University of Chicago.

Smoking and Pregnancy: Make the right choice
Everyone deserves a healthy start in life. Do your patients know that when they smoke that they are not giving their baby everything to start out healthy?  Approaching smoking cessation with a pregnant woman involves sensitivity, tact and objectiveness. Using the ASK, ADVISE and REFER model can help you help your patient quit smoking and let them make the right choice for their baby.

ASK – Do you use tobacco?

TIP:  Ask in a non-judgmental way. Many pregnant women may feel the stigma associated with smoking. If you ask in a non-judgmental way, you will be more likely to get the patient to report their status.

ADVISE – Advise on the health of the mother and the fetus. 

You can explain:
  • The general surgeon’s warning is on the cigarette packet for a reason. “Smoking by pregnant women may result in fetal injury, premature birth, and low birth weight.”
  • Pregnant smokers have a higher chance of miscarriage and stillbirth. Babies of smoking mothers have a higher chance of being born early and too small. Low-birth-weight babies (less than 5 ½ pounds) can suffer serious health problems throughout their lives.
  • Tobacco smoke contains nicotine, arsenic, various tar products, and carbon monoxide. All of these are damaging to the body, and all of them can reach the baby through the placenta.
  • Smoking is harmful to the mother's health and it is the mothers right to choose to smoke. However, her unborn baby doesn’t have the choice, so the mom has to make the healthiest choice for the baby. 

REFER – refer the patient to ASHLine or make the referral for them by calling 1-800-55-66-222 or by contacting the ASHLine web page.  

Q&A
What if they mother does not inhale when she smokes?
Tobacco smoke is absorbed through the mucous membranes of the mother’s mouth and throat. Although it may be less dangerous than inhaling, the mother's body still absorbs harmful elements, and so does the baby.

Provider notifications
Provider notifications contain updates that contain important information. Please click on the link to view the most recent provider notifications in greater detail:  

News and Events
Our News and Events section provides information regarding current news and events, including training opportunities. Please click on the links below to view the most recent news and events in greater detail:
 
Reference Material and Guides
Reference Materials and Guides contain valuable information you may refer to at any time.  There are currently no updates to our Reference Materials and Guides since our last newsletter. 

Mercy Care Advantage Corner

Body Mass Index
Mercy Care Advantage HMO SNP goal for the STAR Measure of Adult body mass index assessment (BMI) is to increase the percentage of members 18-74 years of age who had an outpatient visit and who had their body mass index (BMI) documented during the measurement year or the year prior to the measurement year. 

Measure Requirements are:
  • Members 20 years and older on date of service must indicate weight and BMI during measure year or year prior.
  • Members younger than 20 on date of service must indicate height, weight and BMI percentile during the measure year or year prior (BMI Percentile documented as a value e.g. 85th percentile OR BMI percentile plotted on an age –growth chart).
 
Did you know ?
  • A common deficiency in chart documentation is that only height and weight are documented, with no BMI. 
  • Link from CDC for an Adult BMI Calculator: BMI Calculator
  • ICD-10 codes can be used to make a member compliant without a chart review
Billing Reference

Description           ICD-10
BMI                       Z68.1, Z68.20-Z68.29, Z68.30-
                              Z68.39, Z68.41-Z68.45

BMI Percentile   Z68.51 - Z68.54

For the detailed list with descriptions check out the Provider Outreach Manual: Medicare Advantage Part C STAR Measures page 51: Provider Outreach Manual: Medicare Advantage Part C STAR Measures

Fall Risk Management (FRM)
The following components of this measure assess different facets of fall risk management.

Discussing Fall Risk
The percentage of Medicare members 65 years of age and older who were seen by a practitioner in the past 12 months and who discussed falls or problems with balance or walking with their current practitioner.

Managing Fall Risk
The percentage of Medicare members 65 years of age and older who had a fall or had problems with balance or walking in the past 12 months, who were seen by a practitioner in the past 12 months and who received a recommendation for how to prevent falls or treat problems with balance or walking from their current practitioner.

What can you do to help in the management of members?
Ask patients 65 years of age and older if in the past 12 months, they have fallen or have problems with balance or walking.
Discuss with patients ways in which they can help prevent falls or treat balance problems, such as:
  • Use a cane or walker
  • Suggest taking Vitamin D

Continued in next column

  • Do an exercise or physical therapy program
  • Receive a vision or hearing test.
 
*Information from HEDIS 2018,
Volume 6     

Physical Activity in Older Adults (PAO)
The following components of this measure assess different facets of promoting physical activity in older adults.
  
Discussing Physical Activity
The percentage of Medicare members 65 years of age and older who had a doctor’s visit in the past 12 months and who spoke with a doctor or other health provider about their level of exercise or physical activity.

Advising Physical Activity
The percentage of Medicare members 65 years of age and older who had a doctor’s visit in the past 12 months and who received advice to start, increase or maintain their level of exercise or physical activity.

What can you do to help in the management of members?
  • Ask patients age 65 and older about their level of physical activity and if they exercise regularly.
  • Encourage patients to start to increase or maintain their level of exercise or physical activity

Recommended activities:
  • Start taking stairs
  • Increase walking from 10 min/day to 20 min/day OR maintain your current exercise program
  • Join Mercy Care Advantage’s unique wellness program through the Foundation for Senior Living. The wellness program is offered at multiple locations throughout Maricopa, Pima and Santa Cruz counties. The program offers exercise classes for all fitness levels. Please have the member call one of the numbers below to register for one or more of our programs in your county:   
  • Maricopa: 602-285-0505, ext. 321 or ext. 1
  • Pima or Santa Cruz: 1-866-375-9779, ext. 321 or ext. 17

*Information from HEDIS 2018,
Volume 6
 
Management of Urinary Incontinence in Older Adults (MUI)
The following components of this measure assess different facets of managing urinary incontinence in older adults.
 
Discussing Urinary Incontinence
The percentage of Medicare members 65 years of age and older who reported having urine leakage in the past six months and who discussed their urinary leakage problem with a health care provider.

Treatment of Urinary Incontinence
The percentage of Medicare members 65 years of age and older who reported having urine leakage in the past six months and who discussed treatment options for their urinary incontinence with a health care provider.

Impact of Urinary Incontinence
The percentage of Medicare members 65 years of age and older who reported having urine leakage in the past six months and who reported that urine leakage made them change their daily activities or interfered with their sleep a lot.

Note: A lower rate indicates better performance for this indicator.
 
What can you do to help in the management of members?
Ask patients if they have experienced any leakage of urine or urinary incontinence .
If yes, recommend ways to control or manage urinary incontinence with:
  • Bladder training
  • Exercises
  • Medication
  • Surgery

Make a referral if indicated.
 
*Information from HEDIS 2018,
Volume 6
 
Improving or Maintaining Physical Health             
The goal is to increase the percentage of all plan members whose physical health was the same or better than expected after two years.
 
What can you do to help in the management of members?
Providers can have a direct impact with their interactions with members. Being aware of this measure can help with knowing how and what to ask.

Encourage patients to increase overall physical activity:
  • Ask patients if they are limited in work or daily activities.
  • Ask if pain has interfered with work or daily activities and if yes, recommend appropriate care.
 
Improving or Maintaining Mental Health
The goal is to increase the percentage of members whose mental health was the same or better than expected after two years
 
What can you do to help in the management of members?
Providers can have a direct impact with their interactions with members. Being aware of this measure can help with knowing how and what to ask.

Ask patients if they feel down or hopeless, have trouble sleeping, or have emotional problems that interfere with work, daily or social activities.

Recommend ways they can improve their overall mental health.

Refer as needed to mental health professional.
 
What is the Health Outcomes Survey (HOS)?
  • A CMS sponsored confidential patient- reported survey.
  • A random sample of members are surveyed every April-July and then re-surveyed two years later.
  • Clinical data on the members’ physical and mental health status over time is collected.
  • Uses a set of survey questions known as the Veterans RAND instrument since 2006.
  • There are approximately 68 questions addressing Star measures. 
  • Monitors the performance of Medicare Advantage organizations.
  • Hospice exclusion.
 
What does the Veterans RAND scale cover? *
Physical Functioning : Two questions ask respondents to indicate the extent to which their health limits their physical activities.
Role Physical: Two questions ask respondents whether their physical health limits them in the kind of work or other usual activities they perform, in terms of time and performance.
Body Pain: One question asks respondents to indicate the extent to which pain interferes with the respondent’s normal activities.
General Health: One question asks respondents to rate their current, overall health status. 
Vitality: One question asks respondents to rate their well-being by indicating how frequently they experience energy.
Social Functioning: One question asks respondents to indicate limitations in social functioning that result specifically because of their health.
Role Emotional: Two questions ask respondents if emotional problems have caused them to accomplish less in their work or other usual activities, in terms of time and performance
 
How can providers partner with Mercy Care Advantage to improve HOS measures?
  • Medical staff can have a direct impact with their interactions members.
  • Awareness of these measures can help with knowing what and how to ask patients.
  • Discussions can increase ratings and patient loyalty.
  • Initiate a discussion about the topics below at every visit with patients over 65 years of age.
  • Improving or Maintaining Physical Health
  • Improving or Maintaining Mental Health
  • Management of Urinary Incontinence in Older Adults (MUI)              
  • Monitoring Physical Activity in Older Adults (PAO)
  • Reducing Risk of Falling (FRM)
  • Osteoporosis Testing in Older Women (OTO)         
Mercy Care is Proud to Introduce
Hasani Jackson
Provider Relations Manager 
Mercy Care
Hasani Jackson began her career in the health care industry in 1995 as a Medical Biller. Since that time she has acquired experience in claims processing, claims auditing, and claims reconciliation through positions with Provider Relations, Provider Education and Training, and Management.  Throughout her career, Hasani has worked with a variety of provider types, including, primary care, specialty care, behavioral health, long term care, and dental before joining Mercy Care.
Hasani has been with Mercy Care since September 2017. She currently manages acute care providers, large group primary care physicians, long term care, and hospitals. Before transferring to Mercy Care, Hasani joined Aetna Better Health of Nevada as the Provider Relations Manager in April 2017.

Hasani genuinely enjoys the work she does, both with our providers and members. She enjoys supporting the Provider Relations Department and her assigned team. She sums it up best by stating, “Not only do I love what I do, I strive to do it with integrity, respect and dignity”.
Mercy Care's Executive Leadership
Mercy Care has recently made a few changes to its Leadership, as outlined in the new Organization Chart listed below. We will be highlighting these leaders in our Fall 2018 Provider Newsletter. 
www.MercyCareAZ.org