Mount Sinai Health Partners
Clinically Integrated Network Newsletter
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Leveraging Team-Based Care for High Performance in Primary Care Practice: Interview with Dr. Jonathan Arend, Internist in MSHP’s CIN
We sat down with Dr. Jonathan Arend, an internist at Mount Sinai Doctors Internal Medicine Associates (IMA) to discuss innovative models of care and leveraging a variety of care team members to address complicated patient needs, meeting quality performance standards, and successfully implementing change in a practice.
Click here
to read more.
If you are interested in being featured in the MSHP Provider Spotlight Series, please contact Tiffany Cheng at
Tiffany.Cheng@mountsinai.org
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Mandatory MOC Training for Providers with Patients in Special Needs Plans
The Centers for Medicare and Medicaid (CMS) require all providers who care for patients with Special Needs Plans (SNP), including Dual-Eligible Special Needs Plans (D-SNP), complete Special Needs Plan Model of Care (SNP MOC) training annually and sign an attestation form to confirm you have done so. Please see below for payer-specific information to fulfill this requirement.
Aetna
Providers caring for patients under Aetna’s D-SNP plan must complete the MOC training no later than
December 31, 2019.
Click here to take the online course and complete the
D-SNP MOC Attestation. You do not need to send the attestation form to Aetna or MSHP, but you must keep your record of completion for at least 10 years. Aetna or CMS may ask for documentation to prove you have met these requirements. If you, or your authorized representative, have already completed the D-SNP attestation you may disregard.
Click here for more information.
EmblemHealth
Providers caring for patients under EmblemHealth’s SNP plan must complete the MOC training no later than
December 15, 2019.
Click here for the training. Afterwards,
please complete this attestation form and fax it to 855-685-6250 or mail it back to the address listed on the form.
Village Care Max
Providers caring for patients in SNP plans with Village Care Max must
complete the MOC training and
return the completed
attestation form
to the Provider Relations Department by
December 1, 2019. Fax the attestation form to Village Care Max at 718-517-2698.
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You Asked, We Delivered: New Feature for MSHP’s Online Provider Directory
We are excited to announce a new tool to generate a customized online Provider Directory at our
website
(no log in required).
Generate a specialty-specific provider directory by county and payer in just a few moments!
This directory can be downloaded as a PDF or Excel document and shared with your practice staff and patients.
We encourage you to use this tool to help create community and referral relationships with your peers and keep patient care within the clinically integrated network.
How to Create Directory
- Visit our website and select “Provider Search” from the home page. From there, select the blue circle at the top of the page labeled “Click here to prepare a directory by county, specialty or payer.”
- Select one or more specialties, counties and health plan (default is all health plans) and select how you’d like the output (either PDF or Excel). Your file will be sorted by specialty, zip code, then physician last name.
- Click the “Search” button and a new tab will open with your search results
We thank you for all the feedback we received on the necessity of connecting physicians within the clinically integrated network to help foster referral relationships and more coordinated care. If you have any feedback or suggestions about this new resource, please email us at
mshp@mountsinai.org
.
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Video: Guide on Resources Available on MSHP Website
The
MSHP website
has many valuable resources for you and your practice! Learn more about these resources and where they are located on our website by watching the new
MSHP Website video here.
This video will show you where you can find detailed information and updates on the CIN program, MSHP payers contracts, key forms and guides, and resources to support practice transformation. There is also a quick demonstration on how to use the updated Provider Search feature, where you’ll be able to generate a specialty-specific provider PDF or excel directory by county and payers. The video can also be accessed on MSHP’s
Quick Links webpage.
We also have a written guide on Website Tools and Resources
available here.
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Complete Your 2019 CI Program Requirements by the End of the Year
Be sure to complete your 2019 CI Program Requirements if you have not done so already. The mandatory requirements for the 2019 PCP CI Program are:
- Care Coordination
- Program Engagement
- Practice Engagement
- Privacy Training
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Practice Tips & Transformation
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Expanding Roles of Medical Assistants
Innovative primary care practices across the country have expanded the use of medical assistants to help address challenges in primary care delivery. A review of 15 case studies in
Health Services Research
identifies four categories of MA roles that go beyond escorting patients to rooms and taking their vitals. In these models, MAs worked in relational (health coach, patient navigator), HIT/documentation (EHR super-user, quality improvement assistant), cross-trained (phlebotomy, coding), and managerial (floor coordinator, trainer) roles. Many sites also developed career ladders with financial incentives for their MAs.
Click here to read more
.
At the Union Health Center in Manhattan, MAs act as Patient Care Assistants and provide patient education that had traditionally been assigned to nurses or clinical diabetes educators, assist in translation, act as health coaches for patients with chronic diseases, and scheduling in addition to basic MA responsibilities. The practice has documented reduced patient cycle time, decreased no-show rates, reduced cost, and improvements in quality measures.
Learn more here
.
Ready to add a medical assistant to your staff? Visit our
Practice Resources page
to view a sample job description and an Excel tool to calculate the cost of hiring an MA for your individual practice.
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Empire BlueCross Medicare Advantage Incentive Program: CPT II Codes
Empire is offering a $25 incentive per member per calendar year to all PCPs in their Medicare Advantage network for accurately billing certain CPT II Codes.
Click here
to view the full explanation of the program. Please note that a number of these codes are
also CIN quality reporting measures
.
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Cigna Precertification Updates
Cigna has added 34 CPT codes and 26 HCPCS codes to the precertification list, along with 33 existing CPT codes and 15 HCPCS codes that became effective October 25, 2019. Certain gene therapy injectables have also been added to all product types (previously only on the precertification list for some products). Cigna also removed 40 existing CPT codes and 29 HCPCS codes.
To view an outline of these monthly precertification updates, as well as the complete list of services that
require precertification of coverage, log in to the Cigna for Health Care Professionals website
(
CignaforHCP.com
) and click Precertification Policies under Useful Links. If you are not registered for the
website, go to
CignaforHCP.com
and click Register Now. If you do not have Internet access, and would
like additional information, please call Cigna Customer Service at 800.88Cigna (882.4462).
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Cigna Pharmacy News
Effective January 1, 2020, Cigna is updating their drug formulary to include more preferred brand drugs in key classes and are adding additional clinical utilization management edits for increased savings, quality, and safety for your patients. This is applicable to a number of categories including asthma and COPD inhalers, cardiovascular beta blockers, diabetes, and more. To view all updates,
click here.
Also beginning in January, as a result of Express Scripts joining Cigna, customers who use Cigna Home Delivery Pharmacy will be transitioned to Express Scripts Pharmacy, a Cigna company. For now, please continue to send prescriptions to Cigna Home Delivery Pharmacy unless a patient specifically asks you to send it to Express Scrips. Cigna will notify you when you can begin sending all home delivery prescriptions to Express Scripts Pharmacy.
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Dr. Fields catches up with Dr. Jonathan Arend, an internist at Mount Sinai Doctors Internal Medicine Associates (IMA), Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai, Medical Director for Population Health for the Health System, and Associate Medical Director for Clinical Operations and Clinical Quality at IMA. Dr. Arend and Dr. Fields discuss the value that having a clinical pharmacist on staff adds to his practice, where his patients have a complicated mix of physical and social needs. Dr. Arend shares a variety of roles a PharmD can take on in a primary care practice, discusses his experiences with different models of team-based care, and leveraging non-physician staff to meet patient needs.
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In this episode of the Mount Sinai Health Partners Podcast, Emily Weinger, Program Coordinator for the MSHP Volunteer Program, and Asim Baig, a volunteer in the program, share with Dr. Fields their experiences and triumphs in the program. Unlike traditional hospital-based volunteer programs where roles are typically limited to greeting and transport, volunteers with MSHP act as extended arms of the social workers and care managers. Volunteers perform time-intensive and high-impact activities like researching providers and confirming insurance benefits for patients. Asim, who has a visual disability and has seen the impact social workers and volunteers can make first-hand, says he feels he really makes a difference for patients through this work and can empathize and connect with them despite not working with them directly. On a health system level, the work volunteers do frees up social workers to work at the top of their degrees, spending more time with higher-risk patients in the hospital.
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Flow Chart for Telephone Evaluation of Influenza
Flu season is upon us. Every year, influenza affects millions of Americans. Comprehensive preparedness in primary care includes opportunistic and proactive vaccination campaigns, droplet precaution protocols, phone triage, and timely administration of antivirals.
Follow this link for a CDC flowsheet
to assist office staff with telephone evaluation.
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Population Health in the Literature and Media
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“Tools for Population Health Management” Textbook Chapter by Robert Fields and Niyum Gandhi in
Primary Care: Clinics in Office Practice
MSHP’s Chief Medical Officer, Dr. Robert Fields, and Chief Population Health Officer, Niyum Gandhi,
co-authored a chapter titled “Tools for Population Health Management.”
As health systems transition to value-based models, new tools are necessary to manage networks and operations, such as data integration and visualization. Clinical operations require tools to segment populations into actionable cohorts, create care plans, and share business intelligence. Engagement tools must go beyond education, however, and provide insights at the appropriate times and in the right formats to affect change.
Click here to read more
.
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Kenneth Davis on the Public Charge Rule
Mount Sinai’s President and Chief Executive Officer, Dr. Kenneth Davis, wrote an
opinion piece
for the
New York Daily News
on the “public charge rule” supposed to go into effect in October until federal judge’s issued injunctions blocking its implementation. Dr. Davis discusses how fears of being deemed a “public charge” can cause immigrants to forego preventative care, increasing ED utilization, healthcare spending, and poorer health outcomes.
Read the article here
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P: 877-234-6667
F: 646-537-1481
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