Mount Sinai Health Partners
Clinically Integrated Network Newsletter
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Ed Lucy, Chief Administrative and Contracting Officer for the Mount Sinai Health System, joins Dr. Fields to share his expertise in negotiating payer contracts. Dr. Fields points out that some people feel that we should treat healthcare as any other commodity where there is a market rate loosely tied to cost. But as their conversation reveals, the delivery side is much more complex in that there are multiple challenges to contend with and greater strategic goals that need to be aligned. They also discuss the move toward value-based care, how this differs from capitation contracts that were popular during the 90s, and what population health models may look like in the near future.
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Dr. Fields sits down with Alicia Gresham, Vice President for Network Operations at Mount Sinai, to explore ways for physicians to move towards a population health model that compensates physicians on the quality of care rather than their patient volume. Ms. Gresham explains that it is essential we show physicians what this population health model looks like and how their compensation will change. Physicians may struggle at first with this process, however, in order for physicians to stay sustainable, they must try to transition to a more holistic model of patient care that has been adjusted to our growing health system, staff, and patient needs.
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June 7, 2019
Preliminary datasheets for Q2 quality reporting are available in Box for all providers
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July 10, 2019
2019 Provider Experience Survey due
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July 12, 2019
Q2 quality reporting due for both PCPs and Specialists
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We Want to Hear From You! Important Feedback Needed by Wednesday July 10th
You should have received an email with our 2019 Provider Experience Survey from Mount Sinai Health Partners on June 19th. We would like to hear from you on the communications, services, and resources that we offer. Your feedback is important to us and will help shape strategies for MSHP to improve your experience at the CIN. We would appreciate it if you took a few minutes to share your thoughts with us by Tuesday, July 9th.
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Coming Soon! On July 18th Check out MSHP’s New Website Look and Key Resources
On July 18th, the MSHP website will have a new look and feel to its homepage and behind log-in provider portal landing page. This means you’ll be able to access resources and information quickly and easily.
What can you expect?
- A new navigation and layout on our homepage for easier access to key resources
- A Quick Links button on our home page for quick access to our care management and MSHP support services
- A rotating carousel on our home page highlighting our latest provider spotlights, podcasts, newsletters, and information about MSHP
- A new design for the provider portal where you can more easily click on resources that you need as a CIN physician such as:
- Viewing practice resources,
- Accessing online courses
- Reviewing past e-mails sent by MSHP
- Paying your annual dues, and much more!
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We hope these changes will help make your experience on our website better. If you have any questions or suggestions, please reach out to
tiffany.cheng@mountsinai.org.
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Complete Your Q2 Quality Reporting by July 12
PCPs
As you know, most primary care providers will be performing quality reporting through the Lumeris Accountable Delivery System Platform (ADSP), a mechanism different from last year. All eligible providers/practices should have received on-site training on how to utilize this tool for quality reporting. Quality reporting for Q2 is due by July 12th and will be double counted against your quality performance score in 2019.
Before you begin reporting, all providers should visit their Box folder beginning June 7th for your preliminary data sheets. You will use that as reference when you complete your reporting.
Please click the below links for more information on the reporting mechanism that pertains to you:
Specialists
Your reporting template is now available in your Box account. For instructions, please review the communication you received on
June 7th
. You may also consult the
Quality Reporting Tip Sheet
and view our
Frequently Asked Questions
webpage about quality reporting. For a refresher video on how to complete the quality reporting templates, you may sign in to our
provider portal
and navigate to the “Quality” page.
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Transitional Care Management for Patients with High Medical Complexity
Transitional Care Management (TCM) services should be offered to patients with medical and/or psychosocial problems requiring moderate or high-complexity medical decision making. These services are performed after transitioning patients from various hospital settings including inpatient acute care hospital, inpatient psychiatric hospital, long-term care hospital, and more.
Click here
to find out if your patients qualify for TCM and how you can bill and code for TCM services appropriately.
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EMR offering exclusive for MSHP primary care providers: athenaOne
Increased discounted pricing on athenahealth’s athenaOne product is available to MSHP primary care providers. Mount Sinai Health Partners has a unique connection with athenaOne. Together, we have built a custom interface for MSHP providers to connect with other providers locally and nationally within the athena network. This allows for secure exchange of key patient health information and seamless care coordination to ensure a continuum of quality care for patients. Providers can also run quality reports directly in athenaOne for easy quarterly reporting to fulfill CIN requirements.
To learn more about athenahealth and our new partnership, reach out to Lisa Parent at
lparent@athenahealth.com
or 617-402-6100
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Thank You for Joining Us at Our MSHP Voluntary Town Hall!
Thank you for your attendance and participation at the June 3, 2019 MSHP Town Hall! We hope that you enjoyed celebrating with colleagues and also had the opportunity to connect with them during the dinner and throughout the evening. If you did not complete a paper survey after the Town Hall, please be sure to
share your feedback
with us by Monday, June 17th.
If you were unable to attend or would like a refresher on any of the content presented, we will be uploading the recording to CILC soon.
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Innovations in Care for Patients with IBD
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Refer Your Newly-Diagnosed Patients with Inflammatory Bowel Disease to the Compass IBD™ Program
Physicians at the Susan and Leonard Feinstein Inflammatory Bowel Disease (IBD) Clinical Care Center have developed the Compass IBD™ program to quickly connect recently diagnosed IBD patients to a multi-disciplinary, comprehensive, patient-centered care plan designed to maximize outcomes. Patients in this program are given priority appointments for rapid evaluation. They are then assigned to a team of physicians, nutritionists, social workers, and other health care professionals who create an individualized treatment plan.
If you have a patient who has been diagnosed with IBD in the last 12 months, or who you suspect has a new onset of IBD, we encourage you to refer them to our Compass IBD™ program. Providing early, multi-faceted intervention reduces complications and improves the chances of control of symptoms.
For more information, please go to this
website
or to refer a patient, please call 212-241-8100.
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Practice Tips & Transformation
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“One Thing Different”: Small Interventions Can Make Big Differences for Patients
Dr. Ghazala Sharieff, an emergency medicine physician and Chief Experience Officer of Scripps Health, discusses the “One Thing Different” program in an
article for the
Harvard Business Review
. Dr. Sharieff found that simply asking a patient what their biggest concern was could lead to life-changing care. This initiative asks front-line staff to make one simple change in their daily routines with patients and share them on a dedicated website. With over 4,000 entries in just over a year of the program’s existence, it’s clear that staff have embraced the concept. The result is not only improved patient experience, but staff empowerment as well.
Click here
to read the article or
watch the video here
.
Have you tried changing one small thing in your practice? We’d love to hear about it! Email us at
mshp@mountsinai.org
.
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New Quick Guides: Billing for BMI and CPT II Codes
We are pleased to share two new quick guides with you to help you with CPT II codes and billing for BMI. Click the links below to download, or visit the
Practice Resources page of the
MSHP website after logging in to the Provider Portal.
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Opt in to MSHP Medicaid Value-Based Agreements by July 8
Mount Sinai Health Partners is offering you participation with any Medicaid Value-Based Agreement that MSHP may enter into in the future. MSHP is currently negotiating with and will be entering into Medicaid Value-Based Agreements with a number of health plans. Please note that your decision to opt-in or decline this offer of participation has no bearing on your underlying direct Agreement with the Medicaid plan.
Your participation with Medicaid Value-Based Agreements will help ensure that health plans keep active their existing direct agreement with you so that you may continue to see your Medicaid patients. Participation should also lead to your remaining in the health plans’ Medicaid directories with opportunity to see existing and new patients.
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New Pre-Approval Requirements for Aetna Members
Effective July 1, 2019, Aetna requires authorization for certain outpatient radiation therapy services. In order to be paid for services, you must send authorization requests before providing services. To obtain authorization:
- Go to evicore.com
- 1-888-693-3211 during normal business hours
- Fax a request form (available online) to 1-888-693-3210
If treatment starts before July 1, 2019
, contact eviCore five business days in advance in order to request authorization. This will allow claims for dates of service after July 1, 2019 to be considered.
If a member needs services in less than 48 hours
due to medically urgent conditions, please call eviCore for a fast review. Tell the representative the request is for urgent care.
For more information, please
click here.
For a complete list of procedures that need authorization, visit
evicore.com
.
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New AIM Rehabilitative Program for Empire Patients (PT, OT, and ST)
Effective July 1, 2019, Empire will transition medical necessity review of rehabilitative and habilitative services to AIM Specialty Health (AIM), and add speech therapy service reviews. AIM will begin accepting prior authorization requests on June 17, 2019 for dates of service on and after July 1, 2019.
To obtain authorization:
- Access AIM’s ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
- Access AIM via the Availity Web Portal at availity.com.
- Call the AIM Contact Center toll-free number at 1-877-430-2288, Monday–Friday, 8:00 a.m.–6:00 p.m. ET.
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P: 877-234-6667
F: 646-537-1481
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