Complete Your 2023 CI Program Requirements Now

If you have not completed your 2023 Clinical Integration Program Requirements, you received an email from MSHP on November 7 with details on how to complete your requirements by December 31, 2023. 

Complete your CI Program requirements to remain an active member of the Clinically Integrated Network (CIN).

Questions? Your Population Health Manager and/or Population Health Specialist are available to answer any questions you may have. Feel free to also contact us at mshp@mountsinai.org or 877-234-6667.

Oscar Recoupment Letters

Some CIN providers have received letters from Oscar seeking recoupment of overpayment for services.

You can disregard any such letters dated before October 27, 2023.

Any letters dated on or after October 27, 2023 may be a valid overpayment and a claim refund is due to the plan. These new letters will validate the correct claim and payment amounts due for the corresponding dates of service. You should follow all instructions on any letters dated on or after October 27, 2023.

Please contact the Provider Engagement Team, email us, or call us at 877-234-6667 with any questions.

Learn about perinatal mood disorders

Lauren Blau, PhD will be speaking at our final Mind Matters meeting of the year on Tuesday, December 5, 2023. Attendees will learn how to identify and manage depression and other mood disorders that present during pregnancy, postpartum, or after a miscarriage.

Mind Matters ECHO meetings count towards the CI Program Engagement requirement. If you have not yet fulfilled this requirement be sure to attend!

Close out the year by closing care gaps

Use your October 5, 2023 customized value-based care (VBC) performance reports in your One Drive account to develop your action plan for the rest of the year.

Review these reports to see how you’re performing on quality, clinical documentation (adult PCPs only), and efficiency metrics for patients under VBC contracts. The patient opportunity report (POR) includes patient-level information on care gaps and can be used to identify cohorts of patients that need visits to re-engage in care, close quality care gaps, and/or manage and document chronic conditions.

POR Quick Tip: Be sure to prioritize seeing any Aetna patients on your practice’s POR report by December 31.This will support our network’s Q4 Aetna contract performance. 

MSHP Board of Managers Election concludes tomorrow!

Annual elections for our Board of Managers end tomorrow, November 16.

If you haven’t voted yet, there’s still time! Check your inbox for an email from ElectionBuddy on October 26th to submit your vote. If you do not see the e-mail in your inbox, please be sure to check your spam or junk email folder.

If you have any questions, please email Lauren Hertan, Project Coordinator.

Finerenone for patients with CKD and diabetes

Mineralocorticoid receptor antagonists (MRAs) have a role in reducing albuminuria and kidney fibrosis/inflammation. Use of steroidal MRAs (spironolactone, eplerenone) is often limited by risk of hyperkalemia, especially in combination with ACEi/ARB.

• Recommended for patients with comorbid HFrEF 
• Option for patients with uncontrolled hypertension  

Finerenone is currently the only nonsteroidal MRA with proven clinical kidney and cardiovascular benefits. It has been shown to reduce kidney failure progression and CHF hospitalizations.

It is recommended for patients with diabetes and CKD with eGFR ≥25 mL/min/1.73 m2 and UACR ≥30.

Note: finerenone is only recommended for patients with albuminuria

Diabetes Education and Management Resources

MSHP offers clinical education events throughout the year on a variety of topics. Recent programming has included:

• Obesity management with Dr. Elisa Bocchieri-Bustros
• Complex chronic disease (CKD and diabetes)
• Behavioral health topics

Empire is rebranding to Anthem in 2024

Effective January 1, Empire will be known as Anthem. No action is required and there will be no changes to your agreements or contract, reimbursement, or level of support.

The Medicaid provider call center number is changing. On and after January 1, 2024, call 800-450-8753. All other lines of business/product provider phone numbers remain the same.

Learn more

EmblemHealth SNP MOC Training

All Medicare-enrolled providers are required to complete the Special Needs Plan (SNP) Model of Care (MOC) training for each of the dual-eligible SNPs in which they participate, as mandated by the Centers for Medicare & Medicaid Services (CMS).

Providers in the EmblemHealth VIP Bold and Reserve Networks and the ConnectiCare Choice Network must complete the combined 2023 EmblemHealth and ConnectiCare SNP MOC provider training and submit the attestation.

Payer Newsletters

• Cigna shared their Q4 provider newsletter which includes policy, reimbursement, and pharmacy updates

• EmblemHealth shared their October provider newsletter which includes reimbursement policy updates, authorization guidance, and information regarding the 2022 HHS-Risk Adjustment Data Validation Audit (HHS-RADV)

Keep Care in Network with Our Provider Search Tool

Need help finding a CIN specialist for your patients? Use our Provider Search tool! Search by zip code or name and filter by specialty and/or health plan. You can also prepare a directory by county, specialty, or payer.

To learn more about how to use Provider Search, watch this brief video or review this quick guide.

Welcome to MSHP!

We'd like to extend a warm welcome to the newest member of our Clinically Integrated Network:

Primary Care

Marc Ostreicher, MD

Five Towns Medicine, PC

Cedarhurst, NY 11516