EDUCATION

Educating Patients about Privacy and Security Risks Involved in Telehealth Services

The U.S. Department of Health and Human Services (HHS) improved access to healthcare during the COVID-19 public health emergency by facilitating the increased use of telehealth. As a result of the Department’s actions, healthcare providers have increasingly used telehealth to provide care to patients remotely. The HHS Office for Civil Rights (OCR) supports the continued use of telehealth and has published materials on its website to help entities subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations understand how to provide telehealth in compliance with applicable federal health information privacy, security, and civil rights laws.

OCR is issuing these resources to help healthcare providers explain to patients, in plain language, the health information privacy and security risks that are present when using remote communication technologies, such as video conferencing websites and applications for telehealth. Ensuring the privacy and security of protected health information (PHI) can help promote more effective communication between the provider and patient, which is important for quality care.

While the entire article can be find on the HHS website, we have included a summary of communication points below:

• Before the telehealth session, you can explain what telehealth is and the remote communication technologies that you will use in the telehealth session as part of providing telehealth to your patients.
• Explain why health information privacy and security are important.
• Explain the possible risks to the patient’s PHI when using remote communication technologies for telehealth and ways to mitigate the risks, including viruses and other malware, unauthorized access, and accidental disclosures.
• If you use a remote communication technology vendor(s) for telehealth, provide information about the privacy and security practices of the vendor(s).
• Tell patients that they can file a privacy complaint.

QUALITY IMPROVEMENT

Healthcare Excellence and HEDIS in 2024

As we step into a new year, it's crucial to stay informed about the latest developments in healthcare quality and performance. In this edition, we delve into the Healthcare Effectiveness Data and Information Set (HEDIS) measures for 2024, emphasizing our commitment to delivering top-notch care to our valued patients.

What is HEDIS?

HEDIS, developed by the National Committee for Quality Assurance (NCQA), is a set of performance measures designed to assess the quality of care and services provided by healthcare organizations. It serves as a yardstick for evaluating and comparing healthcare plans across the nation.

Key HEDIS Measure Areas for 2024

1. Prevention & Screening:

• Ensure your patients are up-to-date on essential vaccinations.
• Encourage screenings for conditions such as cancer and diabetes to catch potential issues early.

2. Chronic Disease Management:

• Focus on the management and improvement of chronic conditions like hypertension and diabetes.
• Emphasize patient education for better self-management.

3. Behavioral Health:

• Enhance access to mental health services and follow-up care within 7 days of emergency or hospital care.
• Promote screenings and interventions for substance use disorders.

4. Health Equity:

• Address Social Determinants of Health (SDoH) areas of housing, transportation, safety, and food insecurity that contribute to health disparities and inequities.
• Collect feedback to continuously improve the patient experience.

Over the next few months, you will be hearing from our Quality Improvement team to ensure we are obtaining the most accurate information on your patients to reflect your quality of care. The most efficient way to obtain this information is by providers allowing access to the EMR while our hybrid auditing timeframe is open, which is through May 1st. Please consider this as an option as we contact you.

Thank you for your unwavering dedication to healthcare excellence.

Clinical Practice Guidelines

Looking for a resource to complement your practice and help you stay up to date on the latest recommendations related to preventive screenings or treatment of common medical conditions? Consider reviewing our Clinical Practice Guidelines, which are developed, reviewed, and updated by our Quality Improvement Committee (QIC) with the help of Medical Associates Clinic practitioners.

The QIC reviews the preventive health guidelines annually and all others at least biennially or sooner if updates are released by the US Preventive Services Task Force (USPSTF), professional associations (e.g. American College of Family Physicians), and other creditable bodies. Medical Associates Health Plans (MAHP) has over 30 clinical practice guidelines available on our website on common medical conditions ranging from diabetes management to sinusitis treatment. These guidelines can be found in the Provider section of our website.

CREDENTIALING

Offshore Activities Need Approval

Medical Associates Health Plans (MAHP) is required to notify CMS of its and its contracted providers’ offshore subcontractor activities. Contracted providers that subcontract with any offshore entities to process or have access to patient Protected Health Information (PHI) must notify MAHP and complete an attestation within 30 calendar days from the date a contract is signed or immediately upon knowledge of this requirement. If your group has an offshore subcontractor that has access to ANY members protected health information that has not been approved by MAHP, please refer to the Provider Reference Guide, Section 3 (using the links below) or contact your Provider Relations Representative.

• Medical Associates Health Plans
• Health Choices
• Live360

HEALTHCARE SERVICES

Prior Authorizations

Prior authorizations are necessary to ensure all recommended treatment, testing, and procedures are medically necessary, provided in the most cost-effective setting and are cost-effective options for our members.

The 2024 Prior Authorization lists for our Commercial and Medicare populations are posted in the Provider section of the Medical Associates Health Plans (MAHP) and Live360 websites. Links are provided here for quick reference:

• MAHP Commerical Prior Authorization list
• MAHP Medicare Prior Authorization list
• Live360 Commerical Prior Authorization list
• Live360 Medicare Prior Authorization list

All prior authorization requests should be submitted using our Provider Portal. The portal allows for submission of clinical documentation and any other pertinent information that would aid our staff in their review. If you or your office staff have questions on accessing or utilizing our portal, you can e-mail Member Services at mahpmemberservices@mahealthcare.com.

Medications that are injected or infused at either a provider’s office, outpatient hospital setting, or designated ambulatory infusion center are referred to as Medical Pharmacy. Many medications utilized in these settings require prior authorization. The list of these medications can be found on the MAHP and Live360 websites in the Provider section. We have provided the Medical Pharmacy list here as well for easy access.

Medications that are processed under a member’s prescription drug coverage may require step therapy or prior authorization before the pharmacy can dispense a medication. This link to our Prescription Formulary list will help provide direction to you and your staff. Questions about coverage for prescription medications can be emailed to mahppharmacypool@mahealthcare.com.

Prescription Medication Prior Authorization forms, located on our websites, can be utilized to request a prior authorization for a prescription medication. Any clinical documentation that can be submitted with this form, to help establish that the request meets medical necessity, is appreciated. Completed forms and corresponding documentation can be faxed to our Pharmacy Prior Authorization team at 563-584-4778.

RESOURCES