Review Your April VBC Performance Reports 

On April 3rd, adult PCPs and pediatricians in our network received customized reports in their OneDrive accounts. Please be sure to view these reports — which include the patient opportunity report that shows you patient-level information on care gaps and patients that need to be seen for appointments — and use them for effective patient outreach.

New this year: Adult PCPs also received an In-Network Integration Performance Report, which includes practice-level measures on new office visits to CIN specialists (employed or voluntary) in our 7 focus specialties.

Find Specialists in Your Neighborhood with MSHP’s New Specialist Referral Directories

MSHP recently distributed MSHP Specialist Referral Directories to adult PCPs in our Clinically Integrated Network (CIN).

The directories are comprised of CIN specialists (voluntary and employed) who practice in the following seven specialties that adult PCPs are measured on in the 2024 CI Program In-network Integration program metric:

• Cardiology
• Gastroenterology
• Ophthalmology
• Orthopedics

• Otolaryngology
• Pulmonology
• Urology

As a reminder, the In-Network Integration Metric is a new bonus opportunity metric in the 2024 Clinical Integration Program Scoring and Funds Flow for Adult PCPs. With this metric, Adult PCPs have the opportunity to receive up to 6 bonus points for driving specialty care to in-network CIN specialists. Learn more.

Meet your colleagues in the CIN at our networking dinner in May!

Please join us on Tuesday, May 21 from 6:00-7:30pm for an in-person networking dinner at the Mount Sinai Health System’s corporate space at 150 East 42nd Street in Manhattan.

Why should you join us?

• Get to know your provider colleagues across our clinically integrated network and help keep specialty care in-network
• Forge relationships with in-network CIN cardiologists, gastroenterologists, and ophthalmologists for your patients’ specialty care

Register now for this in-person meeting.

Join us for our next Mind Matters meeting!

Eyal Shemesh, MD, Chief of Behavioral and Developmental Health at Mount Sinai Kravis Children's Hospital, will be speaking at our next Mind Matters meeting on May 8, 2024.

Attendees will learn about the evidence for and against screening for depression in non-mental health settings

and how to interpret USPSTF recommendations into practice.

Dr. Shemesh is trained as both a pediatrician and a psychiatrist. He has published on the emotional impact of chronic illnesses in children and adults, with a special emphasis on distress, posttraumatic stress, depression, and nonadherence to medical treatments.

Contracts and Lab Quick Guides

Review our updated 2024 Value-Based Care Contracts Quick Guide for the most up-to-date information on health plans participating with the CIN, and our updated 2024 Preferred Laboratories Quick Guide to reduce out-of-pocket costs for your patients when they have lab work done.

MSHP Board of Managers Spotlight: Vino K. Palli, MD, MPH

We recently caught up with Dr. Palli, an internist at MiDoctor Health, to learn more about him as a new MSHP Board member! 

What do you like most about serving on MSHP’s Board of Managers?

The opportunity to collaborate with Dr. Arshad Rahim and the other extraordinary physicians and members of MSHP. Their clinical expertise and administrative contributions are commendable, and it's inspiring to be part of such a dedicated team. I am looking forward to working with the Board to benefit our patients and providers, and leverage our collective knowledge and passion for healthcare excellence.

What do you hope to accomplish while serving on MSHP's Board of Managers? 

My background in community-based healthcare, particularly at the intersection of primary and emergency care, gives me a nuanced understanding of the intricate challenges confronting both providers and patients within our healthcare landscape. My hope is to lend this perspective to our collective efforts, ensuring that the strategies we develop are not only clinically sound but also resonate deeply with the diverse needs of our community and providers.

I aspire to elevate the quality of care afforded to all New Yorkers while concurrently fostering a more supportive environment for our healthcare workforce, by not only streamlining care delivery, but also nurturing a culture of professional fulfillment and resilience among our healthcare professionals.

Moreover, I am resolute in my commitment to dismantling disparities in healthcare access and outcomes, particularly among marginalized and underserved populations.

What are your interests/hobbies outside of work?

I like to bike ride along the Hudson, do mindful meditation every morning, and play with my wonderful Australian Shepherd dog named Dr. Nena.

We look forward to Dr. Palli serving on MSHP’s Board of Managers! 

Congratulations to Dr. Arshad Rahim!

Congratulations to our very own Dr. Arshad Rahim on being named one of Becker's Hospital Review 180 chief medical officers to know for 2024!

Over the last 10 years, Dr. Rahim has driven Mount Sinai Health System to become a value-based care leader in the greater New York City market. By driving vastly improved primary care engagement and building and optimizing programs, he has organized cost-effective operations to optimally scale the impact of key value-based care programs. Dr. Rahim also serves on the boards of America's Physician Groups and The National Association of ACOs. He teaches as an assistant professor of general internal medicine and hospital medicine at the Icahn School of Medicine at Mount Sinai Hospital.

Choosing and using inhalers for patients with COPD

Once you've determined which patients should be prescribed inhaler therapy to manage their COPD, follow the below guidelines to choose the right inhaler for your patient, and ensure they use it correctly.

• Weigh access, cost, and patient ability and preference when choosing an inhaler

• Provide instructions and demonstrate proper use

• How to use a metered-dose inhaler (English | Spanish)
• How to use a dry powder inhaler (English | Spanish)
• How to use a nebulizer (English | Spanish)

• Re-check inhaler technique at each visit to ensure continued proper use

• Assess inhaler technique and adherence prior to modifying pharmacological therapy

Refer to the Mount Sinai COPD Quick Reference Guide and COPD Ambulatory Care Pathway for evidence-based best practices to manage COPD in your primary care practice.

Updates from Cigna

Cigna's new Provider Newsroom is now live. There you'll find policy and network updates, industry tools and resources, and more.

Cigna also shared with us that they are now processing payments through Zelis for all Medicare Advantage claims. Learn more about this process, how you'll receive payments, and the ongoing response to the Change Healthcare breach.

Cigna also reminds providers that effective January 1, 2024, for all claims in which the primary diagnosis is indicated as mental health or substance use disorder (MH/SUD), the claim will be paid at the customer’s applicable behavioral benefits cost-sharing amount. This update aligns with the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires all benefits under a plan to be categorized as either medical/surgical or MH/SUD and does not affect provider reimbursement.

EmblemHealth April Provider Newsletter

Emblem shared their April provider newsletter which includes site of service policy updates for injectables and infusions, a reminder that preauthorization fax lines will be disconnected on May 1, and more.

UnitedHealthcare Network News

United shared their latest Network News, which includes information regarding the Change Healthcare cybersecurity incident, reimbursement policy updates, and an updated Prior Authorization Crosswalk.

2024 Member Dues: Please remit payment by May 6

Being a part of Mount Sinai Health Partners means access to enhanced fee schedules with payers, educational courses and tools to help you offer the highest standard of care to your patients, collaboration with a network of high-performing health care providers, and support services to assist you with credentialing, regulatory requirements, and other administrative demands.

To ensure that we can continue to provide value and high-quality service to our network, we collect annual member dues. Refer to the invoice we sent you on March 4 for your annual dues assessment. Please pay online by May 6.

If you have already paid your 2024 Member Dues, thank you and you may disregard this message.

2024 CI Program Materials

Please review the communication we sent on February 13 to learn more about the available program materials and requirements. You can also access these materials through our website (login required).

Complete Your 2024 HIPAA Privacy Training Today

The Health Insurance Portability and Accountability Act (HIPAA) privacy training module is a requirement of the 2024 Clinical Integration Program for all providers and is now available on MSHP’s Clinical Integration Learning Center (CILC) (log in required). 

Complete Your Practice Communication Requirement by Friday, June 28

On March 13, you received this communication on how to complete the mandatory Practice Communication requirement for the 2024 Clinical Integration Program. Please update your practice’s demographic information on the MSHP Practice Profile by June 28, 2024.

Note: Office managers can complete this on behalf of all physicians in your practice.

Welcome to MSHP!

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

Specialty Care

Ume Farwa, MD

Obstetrics & Gynecology

Professional Gynecological Services

Brooklyn, NY

Stephanie Miller, AUD

Audiology

ENT and Allergy Associates

Plainview, NY

Jack Perrone, MD

Obstetrics & Gynecology

Cohen Medical Practice, PC

New York, NY

Natalia Potapova, MD

Ophthalmology

Natalia Potapova Ophthalmology PLLC

New York, NY

Gabriela Rachmaciej, AUD

Audiology

ENT and Allergy Associates

Hackensack, NJ

Marissa Reuter, AUD

Audiology

ENT and Allergy Associates

Brooklyn, NY

Advanced Practice Providers

Danielle Natoli, PA

Physician Assistant

MiDoctor Primary Care/Eastside Physicians of NYC, PLLC

New York, NY