Episode 18: The Changing World of Payer Negotiations with Ed Lucy

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.

Also available through  iTunes  and  Google Play

Episode 19: Building a Network for the Future with Alicia Gresham

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.

Also available through  iTunes  and  Google Play

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?

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. 

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. 

“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 .  

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:

 

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 .  

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:

 

For more information, please click here . 

HealthFirst Assistant Surgeon Reimbursement Rate

Effective August 1, 2019, when billing as an assistant surgeon you will be reimbursed at 16% of the contracted rate under your Provider Agreement. For more information, please click here .

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.