We've prepared the following tips to help you work with your patients to close care gaps for the 2024 CI Program.

QPM Tip: Diagnosing Diabetes

November is National Diabetes Month and serves as an important reminder to help prevent diabetes health complications for your patients living with diabetes. Remember to administer the A1C test to determine if your patients’ diabetes is controlled and the KED test to screen for kidney disease caused by their diabetes.

As a reminder, patients are included in diabetes quality measures by being diagnosed with diabetes, via claims activity. If a diagnosis of diabetes is not supported for a patient, please do not use a diagnosis to obtain a screening test or referral. This will help avoid patients being included incorrectly in diabetes quality measures.  

CDM Tip: Coding and Documentation for Dementia

Clinical documentation and coding should include the guidelines below:

Identify underlying causes of the dementia/neurocognitive disorders whenever possible, such as: Alzheimer's, vascular dementia, neurovascular disorder with Lewy bodies, frontotemporal or mixed dementia, etc.

Determine the severity (mild, moderate, severe, or unspecified) and document within the visit note.

Note: Mild cognitive impairment (MCI) and mild dementia have two distinct codes. Please be sure to clarify the diagnosis in documentation:

Report behavioral disturbances with the appropriate, specific diagnosis codes. Document any known behavioral disturbances based on patient status and medical assessments, and link appropriately to any underlying neurocognitive related conditions.

Examples of individual behavioral symptoms:

If you have not completed your 2024 Clinical Integration Program Requirements, you received an email from MSHP earlier today (November 20) with details on how to complete your requirements by December 31, 2024.

Complete your CI Program requirements to remain an active member of MSHP.

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.

Please focus on bringing in patients who have not yet been seen in 2024, have chronic conditions, and/or open care gaps.

Your practice received updated value-based care performance reports in your OneDrive account in early October. Please refer to the email you received on October 2 for more information. Review your reports to identify patients in need of outreach and gap closure.

Please reach out to your provider engagement team member or medical director if your practice needs any additional support on improving workflows to address open care gaps or how to use the reports.

Voluntary CIN PCPs who care for Aetna Medicare Advantage (MA) and Empire MA patients can earn incentive payments for their help driving Q4 2024 contract performance. Earn incentive payments by scheduling patients not yet seen this year and closing open care gaps.



Eligible providers received a communication with more details on this program on October 7. Please refer to that email for more information and contact your provider engagement team member with any questions.

The latest issue of the Specialist Spotlight is now available! In this issue we introduce you to your community-affiliated and employed colleagues who specialize in Cardiology, Gastroenterology, Ophthalmology, and Urology. Learn about their clinical expertise, personal care philosophy, and how to make a new specialty-care patient referral.

The Specialist Spotlight highlights the following specialties, which are the specialties that adult PCPs are measured on for the 2024 Clinical Integration Program in-network integration metric:

• Cardiology
• Gastroenterology
• Ophthalmology

• Otolaryngology
• Urology

• Pulmonary
• Orthopedics

For a variety of reasons, we have decided to end some of our Medicare Advantage contracts, and will be out of network with Cigna Medicare Advantage plans effective Wednesday, January 1, and with Humana Medicare Advantage plans on Saturday, March 1. Because your Cigna and Humana Medicare Advantage participation is tied to Mount Sinai’s contract, your current network agreements for these Medicare Advantage plans will end at the same time as Mount Sinai’s. 

Please refer to the communication we sent on November 11 with more details about what this means for you and your practice.

In order to better serve our providers and patients, we would like to learn more about the EMR integration capabilities within our voluntary primary care practices. Please complete this brief, mandatory survey by December 10; it should take no more than a few minutes. We thank you for your time!

Annual elections for our Board of Managers began on November 13 and will continue until December 4. 

Ready to cast your vote? Check your inbox for an email from ElectionBuddy with your ballot on November 13. If you do not see the e-mail in your inbox, please be sure to check your spam or junk email folder.

The following voluntary seats are up for re-election and only providers whose main practice are located in the below areas will receive an email to vote:

• Manhattan PCP
• Non-Manhattan PCP
• Non-Manhattan Specialist

Questions? Contact Lauren Hertan, Program Manager at Lauren.Hertan@mountsinai.org or 646-906-2416.

The Mount Sinai Health System Advisory Committee on Immunization Practices provides the following guidance (based on national guidelines) regarding vaccination to our patients, employees, friends, and families for fall/winter 2024.

COVID-19 Vaccine

• All individuals aged six months and older should be offered the updated 2024-2025 COVID-19 vaccine
• Both the Moderna and Pfizer vaccines are approved for individuals aged 12 and older and remain authorized for those 6 months to 11 years old.
• COVID-19 vaccine can be delayed for up to three months from a recent diagnosis of COVID-19

RSV Vaccine in Adult Patients

Pfizer (Abrysvo®) and GSK (Arexvy®) offer RSV vaccines for adults. This year the ACIP made some updated recommendations about who should receive an RSV vaccine.

• Adults 75 years and older should receive a single lifetime dose of a RSV vaccine
• Adults 60-74 years of age at increased risk of severe RSV disease (i.e., chronic heart or lung disease, weakened immune system, severe obesity, severe diabetes, living in nursing home or long-term care) should receive a single lifetime dose of a RSV vaccine
• Those adults who have already received a RSV vaccine do not need another dose
• Pregnant persons should discuss receipt of the Pfizer (Abrysvo®) vaccine with their obstetrician

Flu (Influenza) Vaccine

This year all flu vaccines are trivalent, and everyone aged six months and older should get vaccinated before the end of October.

High-dose Fluzone®, high-dose Flublok®, or Fluad® are recommended for the following patients if available:

• Adults 65 years of age and older
• Adults 18-64 years of age who are solid organ transplant recipients

Lung infections can cause serious problems for people with COPD and other lung diseases. Ensure your patients are up to date on their immunizations against respiratory illness to help keep them healthy.

The table below shows recommended vaccinations for adults with chronic lung disease.

Emblem shared their November provider newsletter, which contains the Annual Provider Notice, as well as other regulatory, compliance, and policy information, training materials, and more.

Humana shared updates to their preauthorization and formulary policies, effective January 1, 2025.

Preauthorization

• Services and medications that may require preauthorization for patients with Medicaid, Medicare Advantage (MA), and dual Medicare-Medicaid coverage
• Prior authorization search tool

Formulary

The commonly prescribed drug list (CPDL) identifies covered prescription drugs in select therapeutic classes that may be the most effective and affordable options for Humana-covered patients. Additionally, Humana’s Medicare Part B step therapy list outlines the preferred physician-administered drugs. 

• Medicare Advantage Prescription Drug Plans CPDL
• Prescription Drug Plans CPD
• Injectable Drugs and Biologics Step Therapy Requirement for MA plans

Users of the CignaforHCP.com portal who have the Delegate access and view delegation history report (website access manager) and/or Enroll and manage electronic funds transfer entitlement(s) will be prompted to add their mobile telephone numbers to their profiles.

Cigna will use multifactor authentication each time you log in to the portal to verify your identity. This enhancement will make it harder for unauthorized parties to log in to user accounts.

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

Advanced Practice Providers

Lily Andrews, NP

Spring Street Dermatology

New York, NY

Rebecca Corbin, NP

Manhattan Valley Pediatrics, LLC

New York, NY

Genet Finnegan, PA

Spring Street Dermatology

New York, NY

Vyacheslav Gulkarov, NP

Igor Rubinshteyn MD, PC

Brooklyn, NY

Joey Pang, PA

Spring Street Dermatology

New York, NY

Yvette Sims, NP

Electra Health Medical P.C.

New York, NY

Alison Whelan, NP

Bethany Medical Clinic of New York, PLLC

New York, NY

Primary Care

Noosheen Javadi, MD

Family Medicine

Upper East Side Medical, PC

New York, NY

Specialty Care

Monica Azmy, MD

Otolaryngology

ENT and Allergy Associates

Old Bridge, NJ

Usmaan Basharat, MD

Otolaryngology

ENT and Allergy Associates

Staten Island, NY

Peter Benedict, MD

Otolaryngology

ENT and Allergy Associates

Staten Island, NY

Mark Boseley, MD

Otolaryngology

ENT and Allergy Associates

Tarrytown, NY

Sabrina Caro, AuD

Audiology

ENT and Allergy Associates

Bronx, NY

Rachel Combs, AuD

Audiology

ENT and Allergy Associates

Franklin Square, NY

Jennifer Curtin, AuD

Audiology

ENT and Allergy Associates

Middletown, NY

Rajool Dave, AuD

Audiology

ENT and Allergy Associates

Somerset, NJ

Gail Delasho, MD

Obstetrics & Gynecology

Electra Health Medical P.C.

New York, NY

Aisleen Diaz, MD

Dermatology

Spring Street Dermatology

New York, NY

Peter Gottlieb, MD

Pulmonary Disease

Richmond Pulmonary Medicine PC

Staten Island, NY

Gwyneth Harrell, AuD

Audiology

ENT and Allergy Associates

New Hyde Park, NY

Carey Kim, MD

Dermatology

Bobby Buka MD, PC

New York, NY

Kalliope Kyriakides, DO

Dermatology

Cindy Hoffman DO, PC

Carmel, NY

Sabrina Malasarte, AuD

Audiology

ENT and Allergy Associates

Brooklyn, NY

Elizabeth Mercado, AuD

Audiology

ENT and Allergy Associates

Brooklyn, NY

Amanda Murdolo, AuD

Audiology

ENT and Allergy Associates

Babylon, NY

Roya Nazarian, MD

Dermatology

Ryan B. Turner MD, P.C.

New York, NY

Nithin Reddy, MD

Dermatology

Bobby Buka MD, PC

New York, NY

Emma Rios, AuD

Audiology

ENT and Allergy Associates

New Windsor, NY

Roshun Sangani, MD

Ophthalmology

Julius Shulman MD PC

New York, NY

Likun Tian, MD

Otolaryngology

ENT and Allergy Associates

New York, NY

Stephanie Tominaga, MD

Otolaryngology

ENT and Allergy Associates

Brooklyn, NY

Emily Tongdee, MD

Dermatology

Mandel-Wilentz Dermatology PLLC

Brooklyn, NY

If you have any questions about any of our announcements, please contact your Population Health Manager, email Mount Sinai Health Partners at mshp@mountsinai.org or call us at 877-234-6667.  

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