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January 25, 2024

In this issue

• Care Transitions Program Expansion
• Supporting Your Practice: Site of Service reminders, CI updates, operations updates and more
• CT Heart Scans Update
• Epic Updates
• CME

Note: When accessing APP Pro links below, you may need to sign in again if you are not taken directly to the referenced page or information.

Our Focus for a Successful 2024

Thank you for your unwavering commitment to the highest quality patient care. In short, you inspire us and we are more committed to supporting your success than ever. We continue our focus on quality, condition management and documentation (CMD) and utilization.

With the new year underway, we continue our focus on quality, condition management and documentation (CMD) and utilization. Read more for areas of focus that can drive our shared success – and resources to support you.

We also thank you for your ongoing engagement. Be sure to review key updates in our February Top 5.

We look forward to our continued partnership this year. As always, thank you for all you do.

Gary Stuck, DO FAAFP

CEO, APP | EVP, Chief Medical Officer, Advocate Health

Don Calcagno, President, APP | SVP, Chief Population Health Officer, Advocate Health

Care Transitions Program Expansion

To deliver on our pledges around clinical preeminence and safety, we are expanding our Enterprise Population Health Care Transitions Program (CTP) on Feb. 6 to include all adult inpatient and observation patients discharged from an Advocate Health Care hospital, excluding behavioral health, maternity and pediatrics.

Key things to know:

• This 30-day program, in which a primary care physician or APC and Care Transitions team actively manage the continuity of care of eligible patients, supports a successful transition home and helps reduce both readmissions and avoidable emergency department visits.
• Based on the Epic Risk of Unplanned Readmission score, eligible patients are initially contacted within 48 hours of discharge, by either a Care Transitions nurse or automated CipherHealth Technology.
• This contact meets the requirement to bill for the Transitional Care Management (TCM) visit in the ambulatory setting and is a heavily weighted measure in our Clinical Integration Program.
• Physicians will now see documentation of the Care Transitions nurse or CipherHealth Technology interaction in Epic Connect or EpicCare Link as Telephone encounters in Chart Review.

Site of Service reminders: With patients at the forefront of everything we do at APP, you have several alternative care settings for procedures including Ambulatory Surgery Centers and physician offices. Learn more about approved options and guidelines for APP Commercial Risk and Medicare Advantage patients. 

Clinical Integration updates: View the latest program updates including 2023 appeals guide and instruction videos, 2024 CI program webinars, and more.

Operations updates: View the latest operations update including general claims information, Power 30 monthly meetings, nebulizer use and more. 

Population health outreach: View the patient outreach being conducted on your behalf to support quality outcomes and close quality care gaps.

Infant RSV prophylaxis update: The CDC revised the RSV prophylaxis recommendations of Beyfortus (nirsevimab) administrations for infants eight to 19 months. Share the parent and guardian education flyer during patient visits and administer weight specific doses between 50 and 100 mg to healthy infants during RSV season or 200 mg to high-risk infants eight to 19 months old in their second RSV season. Refer to the SBAR for more details.

Transition from UpToDate to DynaMedex: Advocate Health is transitioning from UpToDate to DynaMedex as our new online clinical reference tool across the enterprise. We anticipate to go live by the end of Q1. This transition was very carefully considered with input from many of your colleagues, and the evaluation focused on ensuring that DynaMedex is an equivalent to UpToDate. Read more.

Blood donations low: There is a nationwide emergency blood shortage, with the lowest number of people donating blood in 20 years. While our inventory remains steady, please continue your diligence to conserve blood products when possible, especially Group O Positive, O Negative RBCs and platelets. Order and give the right units to your patients and continue to monitor surgical cases for large product needs. You can donate at one of our on-site drives.

$500K awarded to implement research findings, improve outcomes: Advocate Health Care recently received $500K from the Patient-Centered Outcomes Research Institute to allow us to implement evidence-based practices from research findings sooner and improve patient outcomes. Read more about its use.

CT Heart Scans Update

Effective Jan. 30, we will no longer accept self-referrals for CT heart scans. We will continue to offer heart scans at $49 for early diagnosis of heart disease for patients with an electronic or paper order from an established physician or APC. Self-scheduling will also continue in LiveWell and on our consumer websites. Read More.

Medication adherence scoring: Effective Jan. 16, a new Epic feature is available in the inpatient setting and Epic Connect to help support your treatment decisions and boost patient adherence. Medication adherence scores will display by default in Medication History, Medication Reconciliation, Medication Management and PTA sections in encounter navigators. Learn more.

Epic secure texting best practices: Communicating patient care-related information is part of your daily work and sometimes the appropriate communication method is not clear. Learn the do’s and don’ts of texting or messaging within Epic including when collaborating with pharmacists.

Epic Update: Ambulatory Epic Connect: Quest microalbumin update, medication reconciliation flag and more.



Epic Update: Hospital edition: Community resource update, Medication Reconciliation flag, Epic schedule integration with Outlook and more.

In Case You Missed It: Chicago Magazine Top Doctors

The January issue of Chicago magazine recognizes physicians across Chicagoland who were nominated by their peers in its Top Doctors list. Congrats to the physicians who were recognized. Note, we thoroughly vet Top Doctors lists. Some physicians were not included in last APP Key Messages due to an upload error by Chicago magazine in its online list. They have now been added. We apologize for the outdated information and thank you for all you do for our patients!

Get Ready for an Unforgettable Event Honoring Black History

Feb. 6, 11 a.m.- noon

Advocate Health CEO Gene Woods joins us for a vibrant discussion on Black heritage and its impact on his experiences. Register to attend.

Continuing Medical Education

Feb. 7: 17^th Annual Advocate Heart Institute Symposium (virtual and in-person)

Feb. 7: DEI Clinical Quick Bites: Intro to LGBTQ+ Health (virtual)

Feb. 13: MEDtalks: Delirium in an older adult (virtual)

Feb 20: Scientific Grand Rounds: Implementation Science – What is it and why is it important? (virtual)