Announcing New Chief Operating Officer

Jill Mitchell

Chief Operating Officer

Medical Associates Health Plans announces the appointment of Jill Mitchell as its new Chief Operating Officer. In this role Mitchell is responsible for managing day-to-day operations and optimizing internal processes of the company. She was most recently the Director of Finance at Medical Associates Health Plans where she brought leadership and development to the health plans financial operations.

“Jill has been an integral part of Medical Associates Health Plans and holds over 14 years of health insurance experience and knowledge,” stated Zach Keeling, Chief Executive Officer of Medical Associates Clinic and Health Plans. “Her dedication and exceptional performance have been a significant asset and I am confident that her leadership will continue to drive our company’s success.”

Mitchell expressed, “I am honored and excited to assume the role of Chief Operating Officer. Last year Medical Associates Health Plans celebrated a 40-year anniversary of providing excellent service to our members, and I am eager to build on that history and lead our exceptional team as we continue to offer value-based care in the communities we serve.”

The Importance of Preventive Care Screenings & Wellness Visits

Preventive Care Screenings and Wellness Visits allow practices to gain information about the patient, including medical and family history, health risks, specific vitals, and social determinants affecting health (like housing, transportation, and food). The purpose of these visits is to review each patient's overall physical health and psychological well-being, and then develop a personalized wellness plan. These provide an opportunity for providers to assess and improve the quality of care, assist in patient engagement in their care, and help foster healthy communities.

The following screenings provide an opportunity for wellness discussions and care planning at those visits:

• Colorectal Cancer Screening: Such screenings should be recommended for men and women age 45-75. The standard of care is a colonoscopy screening every 10 years or sooner, based on results. Alternatives to a colonoscopy are a flexible sigmoidoscopy every 5 years, multi-target stool DNA test (Cologuard) every 3 years, or an FOBT yearly.
• Breast Cancer Screening: Mammograms should be recommended for women age 50-74, every 1-2 years.
• BMI: Obtain a patient BMI each year, and discuss ways to improve health with physical activity and nutritional/dietary changes.
• Depression Screening: Obtain a patient PHQ-2 each year, at a minimum. If your patient scores higher than 2, complete a PHQ-9 and provide interventions to help decrease depression.
• Anxiety Screening: Obtain a patient GAD-7 each year. If your patient scores higher than 9, further assessment is warranted while providing interventions to help decrease anxiety.
• Unhealthy Alcohol Use Screening and Follow-Up: Obtain a patient AUDIT each year or administer a single-question screening such as: “How many times in the past year have you had 5 (for men) or 4 (for women) or more drinks in a day?” Provide feedback on harms, high-risk situations, and help motivate reduced drinking.
• Social Determinants of Health (SDoH): This tool from the American Academy of Family Physicians can be used to screen patients for SDoH, identify community-based resources to help them, and work with patients to develop an action plan to help reduce health risks and improve outcomes.
• Tobacco Screening: Provide resources to patients to assist in tobacco cessation.
• Immunizations: Become familiar with provider resources as they relate to immunization schedules.

Breast Cancer Screening & Early Detection

In 2023, an estimated 297,790 women and 2,800 men will be diagnosed with a new case of invasive breast cancer, with an additional 55,720 cases of ductal carcinoma in situ (DCIS) in women. An estimated 43,700 women and 530 men will die in 2023 as a result of breast cancer. Invasive female breast cancer incident rates have been increasing by about 0.5% per year since the mid-2000s, likely in part to increased prevalence of excess body weight and reproductive trends.

Based on the most recent data from American Cancer Society, relative survival rates for women diagnosed with breast cancer are:

• 91% at 5 years after diagnosis
• 85% at 10 years after diagnosis

Early detection reduces the risk of death from breast cancer and increases treatment options. The American Cancer Society recommends that women at average risk of developing breast cancer undergo annual mammography beginning at age 45 with the option to transition to biennial mammography beginning at age 55; women ages 40 to 44 should have the option to begin annual mammograms.

Medical Associates Health Plans has adapted this philosophy and goes one step further by allowing a baseline mammogram to be completed between the age of 35 to 39 and then once per calendar year for any women 40 years of age or older.

Flu Season & Vaccination Recommendation

On June 29^th Center for Disease Control and Prevention (CDC) Director adopted the 2023-2024 Advisory Committee on Immunization Practices’ (ACIP) recommendations on annual influenza vaccination for everyone 6 months and older.

The recommended timing of the flu vaccination has not changed. September and October are the best times for most people to get vaccinated, however there are a few considerations for vaccination earlier:

• For adults and pregnant people in the first and second trimester, vaccination in July and August should be avoided unless it won’t be possible to vaccinate in September and October.
• Pregnant people who are in their third trimester can get a flu vaccine in July and August to protect their baby who will be too young to get vaccinated.
• Children who need two doses of flu vaccine should get their first dose of vaccine as soon as vaccine becomes available. The second dose should be given at least four weeks after the first.

The main change in the flu vaccine recommendations is related to giving flu vaccine to people with egg allergies. In the past, ACIP had recommended that all people 6 months and older with egg allergy should be vaccinated for flu with additional safety measures. Additional safety measures are no longer recommended for flu vaccination beyond those recommended for receipt of any vaccine.

The best way to prevent flu and its potential serious complications is by getting a yearly flu vaccine. Even when the vaccine does not prevent the illness entirely, it has been shown to reduce the severity of illness.

Major Depressive Disorder: Documentation and Coding 

Major Depressive Disorder (MDD) is one of the most common brain health disorders in the United States. For some individuals, it can result in severe impairments that interfere with or limit one’s ability to carry out daily life activities. Accurately and completely documenting and coding MDD can help patients access available health care resources to support this condition.

Depression Screening via a PHQ-2 should be completed once per year as part of an annual Wellness Visit. If the patient scores higher than 2, a PHQ-9 should be completed to assess the severity of the depression and interventions should be provided to assist with management of depression.

When documenting and coding for MDD, it’s critical to capture the episode and severity with the most accurate diagnosis codes. Documentation should include:

• Frequency – single or recurrent
• Severity – mild, moderate, severe without psychotic features or severe with psychotic features
• Clinical status of the current episode – in partial or full remission 

F32.9 MDD, single episode, unspecified, is equivalent to Depression Not Otherwise Specified (NOS), Depressive Disorder NOS and Major Depression NOS. This code should rarely be used and only when nothing else, such as the severity or episode, is known about the disorder.

Major Depressive Disorder (MDD) Coding Reference Guide

Best practices include documenting each diagnosis as having been monitored, evaluated, assessed and/or treated and to note any complications with an appropriate treatment plan. We also recommend including Social Determinants of Health (SDoH) ICD-10-CM Z codes on claims so we may utilize this information to track and address the social needs of our members.

For more information, see the ICD-10-CM 2023 Official Guidelines for Coding and Reporting, Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99). 

Updated 2023 Provider Reference Guide Now Available

The Provider Reference Guide has been prepared as a daily reference tool for participating practitioners and their office staff. Access this updated document here. The Reference Guide is password protected. To access the file, please type the following password: provider

Please note that the following policies were recently approved and added to the list of Policy & Procedures in Section 5:

• Telehealth Reimbursement
• Modifier Payment Policy

Medical Associates Health Plans participating providers, click here.

Health Choices participating providers, click here.

Live360 Health Plan participating providers, click here.

Be Sure to Utilize our Online Portal!

Our secure health portals are wonderful online tools that will save you time! Plus, you can access them 24/7. You have the option to ask questions, review eligibility, review claims that you have submitted, review authorization requests that you have submitted, look at the member subscriber agreement and schedule of benefits to verify coverage. You can also enter CPT/HCPCS codes to see if authorization is needed. 

If you have not yet signed up for this time-saving service, you will need your federal tax ID number to create an account. If you have any questions, please e-mail Member Services.

For Your Reference:

Information related to MAHP's quality improvement plan, case management services, disease management services, member rights, communications, appeals process, after-hours assistance, accreditation/awards, and privacy/confidentiality may be viewed at www.mahealthplans.com. Persons without access to the internet may request paper copies by contacting MAHP at 1-800-747-8900 or 563-556-8070. Please ask to speak with a member of the QI team for assistance.