Provider Advisory Group Meeting

November 22, 2019 Lunch: 12:00 pm

Meeting: 12:30 pm – 1:30 pm     

1. Standing Agenda Items 1.1. Welcome and Introduction 1.2. Facilitator: Tahereh Daliri Sherafat, Northern Region Director of Member Services and

Provider Relations Department 1.3. Review of Agenda

2. Old Business

2.1. Review of Minutes  3. Presentation: William Kinder, Senior Manager of OpEx/PMO

Topic: Improving Specialty Access – Why Telehealth? More access to Specialty care and quicker response time for results.

 4. New Business

4.1. PHC Update – David Glossbrenner, M.D.- Medical Director, HS Office of CMO 4.2. Report from the Physician’s Advisory Committee – David Glossbrenner, M.D. 4.3. Update on Quality Improvement Initiatives and Programs

Asthma Medication Ratio Measure: Academic Detailing – David Glossbrenner, M.D. 2020 QIP Gateway Measures- Nancy Steffen, Dir. Quality/Performance Improvement Upcoming Primary Care Provider Quality Improvement Program & HEDIS

Informational Webinars - Nancy Steffen, Dir. Quality/Performance Improvement 2019 PCP QIP Wrap-up Webinar - December 18, 2019 2020 PCP QIP Kick-off Webinar - January 22, 2020 HEDIS 2020 Retrieval Webinar – January 23, 2020

4.4. Report from Provider Education Team – Dani Carpenter, Provider Relations Education Specialist

 5. Provider Topics of Interest

5.1. Topics of Interest, Upcoming Events, Health Fairs and Trainings: All Attendees   

 Meeting Locations: 

 

Video conferencing is available at our PHC regional offices: Northeast Regional Office at 3688 Avtech Parkway, Redding Northwest Regional Office at 1036 5th Street, Suite E, Eureka 

Video conferencing also is available at these non‐PHC offices: Fairchild Medical Center at 444 Bruce Street, Yreka, CA (Board Room) 

Banner Lassen Medical Center at 1800 Spring Ridge Drive, Susanville, CA  

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MEETING MINUTES

Meeting Name: Provider Advisory Group Date: November 22, 2019 Time: 12:15 pm to 1:30 pm Locations: PHC Avtech Office, PHC Eureka Office, Fairchild Hospital, Banner Lassen Medical Center PHC & Guests Attendees (Redding): Jessee Benton, Jennifer Oakes, Sharon McFarlin, Dennis Leale II, Koy Saelee, Kelly Mitchell, Kathy La Mont, Kay Kobe DC, Chris Kobe DC, Nancy Steffen, Dani Carpenter, Tahereh Daliri Sherafat, William Kinder, David Glossbrenner MD. PHC & Guests Attendees (Eureka): Mai Houlberg, Matt Rees, Paul Keltner, Michael Franklin, Shell Swift, Jeff Ribordy MD, Cindy Ashton PHC & Guests (Fairchild Hospital): Kim Palfini, Linda Nichols, Lori Padilla, Michelle Harris, Cathy Hill, Becky Smith, Jo Guasco, Michelle Line, Amanda Johnson, Rick Sommer, Christine Walters, Vina Swenson, Rachel, Horn PHC & Guests (Banner Lassen Medical Center): Kyli Sinner, Sarah Garate, Jamie McMullen, Carrie Breaux, Taylor Moore, Catherine Hanson

Agenda Topic Minutes Action Items Welcome/Review of Minutes/Review of Agenda

1.1 Welcome and Introductions: Tahereh Daliri Sherafat 1.2 Review of Minutes 1.3 Review of Agenda

Minutes Approved by Shell Swift, seconded by Dr. Ribordy

Presentation

2.1 Improving Specialty Access – William Kinder, Senior Manager of OpEx/PMO, Partnership HealthPlan of California.

• Barriers to healthcare include transportation and patient travel time, economic struggles: work, gas, child care, and member discomfort with a new doctor. Telehealth addresses these concerns, allows greater access to specialty care, reduces appointment wait times, and results in more positive outcomes.

• PHC members can access telehealth providers via TeleMed2U in all of our Northern Counties, as well as areas of Mendocino, Lake, and Sonoma Counties.

• Available specialties are Dermatology, Diabetic Education, Endocrinology, Gastroenterology, Infectious Disease, Nephrology, Neurology, Nutrition, Pain Management, Psychiatry, Pulmonology, Rheumatology, and Urology.

• More than $800,000 has been given to sites participating in the Telehealth Coordinator Support Grant.

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Old Business

3.1 None None

New Business: 4.1 PHC Update 4.2 Report from PAC 4.3 Update from Quality Department 4.4 AMR Academic Detailing 4.5 Report from Provider Education Team

4.1 PHC Update: David Glossbrenner, M.D., Medical Director, HS Office of CMO

• The Wellness and Recovery Program allows counties to provide increased access to substance abuse treatment resources.

• NCQA- Audit in 1 year. • Health Services working with Providers across borders to contract with PHC.

4.2 Report from Physicians Advisory Committee: David Glossbrenner, M.D., Medical Director, HS Office of CMO

• Proposition 56 provides incentive payments to providers based on several new quality initiatives, including Behavioral Health Integration Grants, Family Planning Incentives, and Developmental screening.

4.3 Update from the Quality Department: Nancy Steffen, Director of Quality/Performance Improvement

• Asthma Medication Ratio Measure (update given by Dr. Glossbrenner) Goal to improve asthma conditions in Pediatrics and adults. AMR encourages providers to work with members on preventive medicines.

• 2020 QIP Gateway Measures • Upcoming Primary Care Provider Quality Improvement

None

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Provider Topics of Interest Speaker: All

None

Next Meeting February 7, 2020 Any suggestions for next agenda- None

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MEETING MINUTES

Meeting Name: Provider Advisory Group Date: August 16, 2019 Time: 12:15 pm to 1:30 pm Location: Redding Avtech Location Hosting, Eureka office, Fairfield Office, Santa Rosa Office, Attendees: Vita Marks, Stephanie Tarter, Tracy Kamelamela, Mike Palomino, Alyssa Alvarez, Karen Sprague, Kristy Woolworth, Kim Hill, Pam Sakamdo, B. Oduri, Mark Aguirre, Cristina Mallari, Amor Venzon, Jeanette Camarena, Lisa Parris, Janis Polos, Marianne Hutchins, Shell Swift, Deb Mithchell, Tessa Stone, Cara Figus, Sandra Jones, Kristen Rees, Nai Chadderdon, Chloe Schefr, Matthew Ware, Trina Arreola, Paul Davis, J. Kingsley, Dani Carpenter, Nancy Steffen, James Devan, Charlene Dunn, Britnee Torres, Demi White, Stephanie Austin, Sarah Ullerig, Katie Whaler, Summer Berfer, Amber Bidwell, Angela Morrissey, Martha Ugbinada, Sarah Joy, Amanda Ponti, Jonathan Crnkoric, Kimberli Frantz, Dawn Cline, Tara Fogliasso, Kim Fillettee, David Glosbrenner, Kathy Hiatt, Sonja Campbell, Cindy Arbariobella, M Kubuta, Milissa Perez, Stephanie N. Claudia W, Danny T, Karin Pimentel, Beth Dadko, Gloria Turner, Matt Gal, Beckey Backer, Mark Netherda, Maisha Smith, Shaughn Whittaker, Carrioe Breaux, Shona Hillman, Laura Boughanger, Jamie McMuller, Jennifer Oakes, Tahereh Daliri Sherafat, Sharon McFarlin, Barbara Crandall, Kim Palfini, F. Chrtjour, PHC Sites: Redding-Avtech, Eureka, Fairfield, Santa Rosa Non PHC Sites: Fairchild Hospital, Banner Lassen

Agenda Topic Minutes Action Items Welcome/Review of Minutes/Review of Agenda Speaker: Tahereh Daliri Sherafat

Minutes approved by Trina Arreola from Redding Rancheria and seconded by Britnee Torres from Churn Creek Healthcare

None

New Business Speaker: Dr. David Glossbrenner

2.1 PHC Administrative Update – David Glossbrenner M.D • Due to the future plans of the Pharmacy Benefit in Medi-Cal

back to a centralized State function. Executive leadership has been engaged in providing the State Government with their thoughts, both as PHC leaders but also through state-wide organizations, about this directive. The State gives every indication that they intend to move forward rapidly with this project.

• PHC completed its budget process for the coming year. We held a Leadership Retreat, and we held our first Joint Leadership Initiative (JLI) meeting with Shasta Community Health. These JLI meetings will be held with a number of the larger provider

None

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organizations with the intent of communicating specifics on such things as HEDIS performance and providing the organizations access to senior PHC leadership so that they can communicate needs, what has been working, and what needs work.

• PHC received interim accreditation from NCQA yesterday. This means that we can now prepare for our initial full survey. It is our expectation that this survey will be sometime in November 2020. Some of the activities that PHC will engage in to prepare for this survey will impact providers. This is particularly true in the area of HEDIS.

• A video production is being presented here in Redding on Thursday, September 12th. This movie will be at the Cascade Theater starting at 6 PM and it is free to the public but you need tickets. The movie is called “Written Off – Shining Light on Opioid Addiction in Shasta County”.

2.2 Report from Physician’s Advisory Committee – David Glossbrenner M.D., • The State has indicated that all services covered under Medi-Cal

can be provided via telemedicine. This is an administrative clarification and is a good thing for rural providers.

• Dr. Moore spent time delineating five areas where Proposition 56 monies will be allocated. Proposition 56 was passed in 2016 and added a $2 tax on each package of cigarettes. It went into effect April 2017. The areas discussed by Dr. Moore were

• Healthcare provider loan repayment. This is several hundred million dollars directed at paying off loans. The first batch of providers to receive this has already been designated. There will be an application period next year as well.

• Value Based Payments. This is a program built around 17 measures. Some but not all are already measures tracked by HEDIS. Organizations that receive a Prospective Payment rate

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(PPS) are not eligible for this program • Development Screen for Children. Providers can receive

enhanced payments for certain developmental screens. PPS providers are eligible for this.

• Family Planning. There is considerable money allocated for this area. PPS providers are not eligible for this.

• Behavioral Health Integration Grants. This is a grant structure and I believe it is open to all organizations.

2.3 Provider Relations – Training and Events Calendar - Tahereh Daliri Sherafat • NR October trainings focus is on Member Outreach and

Grievance. 2.4 Report from Provider Education Team – Bianca, Manager of

Provider Education, Provider Relations Department, Partnership HealthPlan of California • View attached handouts

Provider Topics of Interest Speaker: All

Siskiyou County events- 10/17/19 Introduction to Autism Spectrum Disorders, Early Warning Signs and Characteristics, 8/29/19 Dr. Sonja de Boer Training on Autism for Babies, Toddlers & Preschoolers. Shasta County -10/9/19 Tribal Health mobile mammography screening

None

Presenter: Subject Matter Experts from Partnership HealthPlan of California Topics will include the following HEDIS measures:

View attached PPT None

Next Meeting November 15, 2019 Any suggestions for next agenda- None

Improving Specialty Access – Why

Telehealth?

William KinderSenior Manager of OpEx/Project

Management Office

11/22/2019

PHC & Telehealth

2Sometimes telehealth is the only option

Telehealth Program

Northern Sites in PHC Telehealth Program

Del Norte• Open Door - Del Norte Community Health Center (V, EC)

Humboldt County • Karuk – Orleans Medical Clinic (V, EC, IHS) • K’ima:w Medical Center (V, EC, HIS)• Open Door - Eureka Community Health Center (V, EC • Open Door - Ferndale Community Health Center (EC) • Open Door - Fortuna Community Health Center (EC) • Open Door - Humboldt Open Door Clinic (V, EC) • Open Door - Mckinleyville Community Health Center (EC) • Open Door - NorthCountry Clinic (EC) • Open Door - Redwood Community Health Center (EC) • Open Door - Willow Creek Community Health (V, EC) • Redwoods Rural Health Clinic (V)

Lassen County • Northeastern Rural Health Clinic (V, EC) • Westwood Family Practice (V, EC)

Modoc County • Modoc Medical Center (V)

Shasta County • Mayers Memorial Hospital (V, EC) • Shasta Community Health Center (V)

Siskiyou County • Fairchild Medical Center (V) • Karuk - Happy Camp Clinic (V, EC, IHS) • Karuk - Yreka Medical Clinic (V, EC, IHS)• Shasta Cascade - McCloud Healthcare Clinic (V, EC) • Shasta Cascade -Dunsmuir Community Health Center (V, EC) • Shasta Cascade -Shasta Valley Community Health Center (V,

EC

Trinity County • Hayfork Community Clinic (V) • Trinity Community Health (V) • Redding Rancheria Trinity Health Center (V, IHS)

Specialty Care Access

BarriersTransportation and patient travel times

Economic struggles – Work, gas, child care

Unresolved patient health issues Uncomfortable with new doctor

SolutionsPHC supports Specialty Access via video and electronic consultation

PHC provides platform, training, financial resource assistance

OutcomesAllows real-time specialist visit Reduces appointment wait times

Increased compliance Eliminates need to travel

Treatment recommendations Diagnosis through treatment plans

Modes of Telehealth

Synchronous Traditional

• Video Consultations

Asynchronous Store & Forward

• *eConsult

*eConsult has proven to be a valuable telehealth service to assist PCP’s to provide improved member care at sites lacking specialty providers.

• Contracted with TeleMed2U to provide a telehealth specialty network

• Contracted with Safety Net Connect to provide the eConsult platform

• Specialty Network available to PCP’s utilizing a secure HIPAA compliant system provided by PHC.

• Specialist (TeleMed2U) costs directly billed to PHC

Specialty Access through Telehealth

PHC Telehealth Program:

Telehealth Program Summary

Video Consultations

• Coordinator support grant

• Comprehensive onboarding

• Dedicated program support

eConsult

• Fully-funded platform

• Fully-funded training

• Dedicated program support

Available specialties: Dermatology, Diabetic Education,Endocrinology, Gastroenterology, Infectious Disease, Nephrology,Neurology, Nutrition, Pain Management, Psychiatry, Pulmonology,Rheumatology, Urology

PHC partners with TeleMed2U (TM2U) to provide video telehealth consultative services to PHC adult members

Video Program Benefits

Program Highlights

NO RAF requirement Shorter wait, travel times for patients

NO purchasing blocks of time Access to telehealth coordinator support

NO coordinator/staff training cost Access to 10+ specialty services

PCP identifies need & refers

patient to telehealth

coordinator

Telehealth coordinator

books appointment

Patient shows up

for telehealth

visit

Patient & specialist

interact over secure

network

Patient receives

care/ treatment

plan

PCP site bills PHC

for associated

costs

Specialist bills PHC

Video Specialties

Current Video Specialties Available

• Dermatology• Endocrinology• Gastroenterology• Infectious Diseases• Nephrology• Neurology

• Nutrition• Psychiatry• Pulmonology• Rheumatology• Urology

Video Visits by Specialties

6

972

72 1162

222291

769

20

950

17

2019 Video visits by Specialty

PHC provides the eConsult platform for specialty consultation questions to specialists.

eConsult Program Benefits

Program Highlights

NO platform usage fees Increased PCP to specialist communication

Accessibility from any PC, tablet or smart device

Maintain continuity of care

8 specialties currently available Specialist response average 24 hours

Improved patient screening beforereferring for face-to-face specialist visit

Addresses patient needs over 50% of the time

PCPs office logs in and submits the

specialty eConsult

Specialist receives HIPAA-

compliant email alert from PCP

Specialist logs into eConsult system to

review and respond to

PCP

PCP and specialist

communicate until issue is

resolved

eConsult is closed

Specialist submits claim to

PHC

eConsult Specialties

Current eConsult Specialties Available

• Dermatology• Endocrinology• Gastroenterology• Infectious Diseases

• Neurology• Pain Management• Rheumatology• Urology

eConsult Specialty Utilization

14

223

274

27

125 130

5

162

19

0

50

100

150

200

250

3002019 eConsults by Specialty

eConsult Close Codes

5%10%

28%

54%

3%

Breakdown of eConsult Close Codes

Pending Diagnostics

Pending Therapeutic Trial

Refer for Face-to-Face Visit

Patients Needs Addressed

Specialty Change

Benefits of eConsult PHC Member Clinic/HCLowers cost of care XLowers time to care X X XLimits out of network referrals X X XIncreases quality of referrals X X XReduces distance to care X X XReduce wasted coordinator time XPCP can gain knowledge XContinuity of care X XReduce "no shows" X X

Who Benefits from eConsult?

• Lack of space/staff/equipment• Physical space for live video visits• Administrative/coordination staff time• Equipment

• Internal adoption (sites)• Staffing - coordination• Executive team and physician engagement• Revised workflow• Key staff retention

Challenges and Barriers

17

• Telehealth coordinator support grant

• Comprehensive onboarding

• Full-time PHC telehealth support team

• PHC hosted telehealth coordinator forums

PHC Support

18

Specialty Referral Data by County

Based on 2019 data for specialties offered in PHC Telehealth program

CountyNumber of Referrals

sent

Number of

Resulting Visits

Average number of days for an in person referral

Top 3 Utilized Specialties per county

Del Norte 773 287 43Dermatology, Gastroenterology, Neurology

Humboldt 2414 989 41Dermatology, Gastroenterology, Neurology

Lassen 321 100 41Gastroenterology, Neurology, Pain Management

Modoc 177 47 41 Gastroenterology, Neurology, Pulmonary

Shasta 4919 2039 34 Gastroenterology, Neurology, Pulmonary

Siskiyou 889 297 40 Dermatology, Neurology, Pulmonary

Trinity 265 104 36 Dermatology, Neurology, Pulmonary

• To help offset some of the cost of a Telehealth Program• Per CTRC only plan they’re aware of that is providing this

• Not contingent on using TM2U

• Allow sites to use other providers to serve our members

• Incentivize eConsult

• Incentivize outside referrals

• Semi-annual payout

• Making a two-pronged incentive program: • 1st component based on total utilization• 2nd component is based on utilization percentage of total member

population

Telehealth Coordinator Support Grant

Telehealth Support Grant for Southern Sites

Over $800,000 of grant support to sites participating in PHC program

$-

$10,000.00

$20,000.00

$30,000.00

$40,000.00

$50,000.00

$60,000.00

$70,000.00

$80,000.00

$90,000.00

$100,000.00

6/30/2016 12/31/2016 6/30/2017 12/31/2017 6/30/2018 12/31/2018 6/30/2019 9/30/2019

Grant Funding by Region Since Inception

Southern Region $258,417.00 Northern Region $548,000.00

“We had some initial hesitation at first but found eConsult to be a goodsupport system for the hospital. Mayers Memorial uses eConsult as a tracker,as a follow up tool for the PCPs, and it’s easy for the specialist to keep trackof patients and care since they can also log on in real time to the system. Weuse eConsult for a few specialties like Hep-C and Nutrition, Dr. Siddiqui ourHep-C specialist loves the tool because he is able to follow up on patientswho have treatments that can go 2-6 weeks. Also, our lab results go right tothe specialist when we submit them to eConsult.”-Amanda Harris, Mayers Memorial Hospital

“We just started using eConsult in January 2019. We require eConsult beused first for referrals so we are encouraging our providers to use eConsultfor all specialties especially those specialties that they would not normallythink to use it for. We continue to educate our internal leadership teamsabout eConsult at every chance as well. Training with Safety Net Connect(SNC) and PHC went well. They helped to create a workflow using ourexisting process. eConsult has been seamless and has made our referralprocess a lot easier.”-Amy Puckett, West County Health Centers

Testimonials

23

Open Door/PHC Specialty Care Model

“In our rural setting, we have limited access to specialists. I’m an advocate for eConsult and Telehealth as it addresses the barriers that often come with care in the rural setting. Our goal is to provide timely, quality care. Utilizing eConsult, we’ve seen a reduction in travel and wait times for our patients; a significant drop in the number of days the patient’s health care needs are addressed; and a reduction in face to face specialty visits.

Every referral, that is feasible, should be sent to eConsult. If a specialist can review it, there is no downside. Let’s meet our patients where they are at.”

Dr. Willard Hunter,Open Door Community Health Center, CMO

PHC telehealth team: telemedicine@partnershiphp.org

PHC eConsult email: econsult@partnershiphp.org

TeleMed2U: https://www.telemed2u.com/

PHC telehealth policy: www.partnershiphp.org

CTN: https://www.caltelehealth.org/

CTRC: http://www.caltrc.org/knowledge-center/training/

Center for Connected Health Policy (CCHP): http://www.cchpca.org/jurisdiction/california

Important Resources & Contacts

Eureka | Fairfield | Redding | Santa Rosa (800) 863-4155 | telemedicine@partnershiphp.org

About our Program

A common obstacle patients face is accessing specialty care services within their local communities. Healthcare organizations can help to eliminate this obstacle by participating in PHC’s telehealth program. Our program offers accessibility, affordability and timely access to care for patients to help them obtain the care they need. Our program offers implementation training and support, flexible telehealth scheduling and access to over 15 specialties. We are partnered with TeleMed2U which is a California based and Medi-Cal approved multi-specialty provider. Their team of providers are board certified and credentialed and participate in both video (synchronous) and eConsult (asynchronous) telehealth modalities. Our program provides continuity of care for patients and has shown proven results through both patient and provider satisfaction surveys.

Program Benefits

Video eConsult No RAF requirement No platform fees Less travel for patients HIPAA compliant Decreased appointment wait times Direct contact with specialists No block time requirements Response within 24-48 hours Dedicated specialists Easily accessible

Available Specialties

“It is amazing to provide specialty services via TeleMed2U. These patients can be hundreds of

miles away and I simply connect to them and can speak to them and examine them real time....” - TeleMed2U Otolaryngologist since 2015

Cardiology Dermatology Diabetic Education Endocrinology Gastroenterology

Infectious Disease Hematology/Oncology Hepatology Nephrology Neurology

Nutrition Pulmonology Rheumatology Urology Women’s Health

Telehealth Specialty Access

Partnership HealthPlan of California

Focuses on Asthma

Eureka | Fairfield | Redding | Santa Rosa (800) 863-4155 | www.partnershiphp.org

Partnership HealthPlan of California (PHC) is pleased to offer academic detailing about the Asthma Medication Ratio (AMR) HEDIS® measure

and best practices for Asthma Care.

The Asthma Medication Ratio is a valuable tool in asthma management because it assesses medication therapy adherence in patients with persistent asthma

and can be used as a tool to monitor asthma control.

PHC regional medical directors and

pharmacists will review recent updates in

guidelines for optimizing asthma

diagnosis and management.

AMR is a ratio of asthma controller

medications to total asthma medications. PHC pharmacists will review changes to the

PHC formulary that align with new treatment

guidelines

Review your practice’s current performance on the AMR measure and identify which patients may be

included and excluded.

Learn how to utilize the AMR ratio to identify which patients need

support controlling their asthma.

Clinical Practice

Pharmacy HEDIS® & QIP

AMR ACADEMIC DETAILING SESSIONS FOR YOUR STAFF

All staff play a role in affecting AMR performance.

Getting all staff together can be challenging. PHC can tailor AMR academic detailing sessions to individual audiences (e.g., clinicians, QI, front and back office staff) to meet your practice’s scheduling needs.

To schedule a visit with your primary care site, reach out to your PHC Provider Relations representative or email ccuthbertson@partnershiphp.org with your request.

Who should attend?

• Providers • Nurses • Front office • Back office • Quality

Eureka | Fairfield | Redding | Santa Rosa

Email: HEDISMRA@partnershiphp.org | Phone: (866) 828-2302 | Fax: (707) 863-4314

Date: Activity:

Due Dec 13th 2019 Annual Provider Information Form

Jan. 23, 2020 HEDIS 2020 On-Site Retrieval Webinar

Week of Feb. 10, 2020

KDJ will send out provider packages, which include the member pull lists, to all EMR Remote Providers

PHC will outreach to begin scheduling all providers for on-site and fax/mail retrieval

Feb. 2020 – Mar. 2020 Primary Medical Record Retrieval & Review

Apr. 2020 Secondary Medical Record Retrieval

May 8, 2020 All Medical Record Retrieval and review must stop per NCQA timeline

May 11-15, 2020 Medical Record Review Validation Audit

Jun. 2020 Final rates are locked and reported to DHCS

Jun. 15, 2020 Providers can de-activate KDJs EMR Remote Access

Credentials

Aug. 2020 HEDIS 2019 Performance will be shared with provider network

PHC HEDIS Newsletter Winter 2019

HEDIS 2020 Retrieval Webinar

This webinar will provide a comprehensive overview of the medical record retrieval process including a high-level timeline of HEDIS activity, highlight changes to the 2020 Measurement Set,

and provide key resources. We encourage anyone in your quality staff

and medical records staff to join us.

Date: Thursday, January 23, 2020 Time: Noon – 1 p.m. Registration:

https://attendee.gotowebinar.com/register

/1089183218247193090

Annual Provider Information Form

Partnership is asking for less than ten minutes of your time to complete the

annual provider information form. This form will collect key information

regarding your site to improve efficiency in retrieving appropriate medical record documentation. *Please note if you have

already filled out the EMR remote retrieval form, you do not need to fill out

this form.

Return by: Dec. 13th, 2019

Link to Form: https://www.surveymonkey.com/r/PHC_PIF2020

EMR Remote Retrieval HEDIS 2020

If your site is interested in remote retrieval for HEDIS 2020, please visit our webpage here to learn more about remote retrieval at Partnership. You may also email our HEDISMRA@partnershiphp.org inbox and a HEDIS team member will respond to your inquiry.

HEDIS 2020 Is Almost Here!

HEDIS 2020 kicks off in February. In preparation for the HEDIS 2020 Medical Record Retrieval season, see the following timeline including the upcoming activity with our retrieval vendor, KDJ.

HEDIS 2020 Medical Record Retrieval Reminders

For HEDIS 2020, PHC will be internally conducting retrieval for all on-site and fax/mail retrieval. You can learn more about this change during our “ HEDIS 2020 Retrieval Webinar” (info in side bar)

When sending Medical Records requests to PHC, or any of PHC’s contracted vendors, please Do Not include any behavioral health records. Behavioral health records do not provide any compliant HEDIS data.

TELEHEALTH POLICY UPDATES

October 2019

Eureka | Fairfield | Redding | Santa Rosa (800) 863-4155 | www.partnershiphp.org

The Department of Health Care Services defines telehealth as “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site, and the health care provider is at a distant site.”

The following is effective for dates of service on or after July 1, 2019:

• Each telehealth provider must be licensed in the state of California, enrolled as a Medi-Cal provider, and must reside in California (or a border community).

• Health care providers are required to document place of service code: 02 on the claim, which indicates that services were provided or received through a telecommunications system. The Place of Service Code 02 requirement is not applicable for FQHCs, RHCs or Indian Health Services (IHS).

The health care provider at the distant site must:

• Create and maintain record of the review and analysis of the transmitted information with written documentation of date of service and time spent (between 5 and 30 minutes).

• Record a written report of case findings and recommendations with conveyance to the originating site.

• Record the maintenance of transmitted medical records in patient’s medical record.

Covered benefits or services provided via a telehealth modality are reimbursable when billed in one of two ways:

• For services or benefits provided via synchronous, interactive audio and telecommunications systems, the health care provider at the distant site bills with modifier 95.

• For services or benefits provided via asynchronous store and forward telecommunications systems, the health care provider at the distant site bills with modifier GQ.

Telephone or video visits: Any clinician eligible to bill for office visits may conduct a telephone or video visit with a patient in lieu of an office visit. Such visits must last at least 5 minutes, and be documented in the medical record.

• Required Codes – telephone or video visits with provider in office and patient remote from office (in lieu of office visit).

o G0071 (FQHC) o G2012 (other providers)

Provider introduction to the new

ACEs Aware Initiative

12:15 – 1:00 p.m. December 4, 2019 The Office of the California Surgeon General and the Department of Health Care Services (DHCS), in the first public unveiling of the initiative, will host a live webinar to share details of the new ACEs Aware Initiative for Medi-Cal providers on Wednesday, December 4, 2019 at 12:15 p.m., PT.

During the webinar, California Surgeon General Dr. Nadine Burke Harris and Dr. Karen Mark, Medical Director for DHCS, will share the approach for creating curriculum and training to prepare providers to screen for Adverse Childhood Experiences (ACEs) and respond with trauma informed care. They will issue a call to action for Medi-Cal providers to join in the launch of this unprecedented initiative and share details about the larger strategy to ensure that all California communities are ACEs Aware.

Additionally, Dr. Burke Harris and Dr. Mark will explain how providers, beginning January 1, 2020, can collect payment for conducting ACEs screenings with their Med-Cal patients.

Registration: Click on the link below or copy and paste into browser to register

https://register.gotowebinar.com/register/8198290052584228876

Eureka | Fairfield | Redding | Santa Rosa

(800) 863-4155 | www.partnershiphp.org

SAVE THE DATE:

ACEs Aware Provider Webinar

Public Safety Power Shutoff

Power Outage Reporting AFL 19-30.1

Eureka | Fairfield | Redding | Santa Rosa

(800) 863-4155 | www.partnershiphp.org

November 2019

Partnership HealthPlan of California (PHC) has received updated information to All Facilities Letter

(AFL) 19-30.1 to share with providers. In an effort to keep communities safe from wildfire and

extreme weather events, California energy companies may proactively turn off electric power to any

electric customer as a part of a Public Safety Power Shutoff (PSPS) event. PSPS events, when

used, are regarded as an unusual occurrence. Facilities should ensure their local energy company is

provided with the most up-to-date contact information to receive outage alerts and must have

contingency plans in place to deal with the loss of power. Below is more information on reporting, as

highlighted in the updated AFL.

Who is required to Report:

Acute Psychiatric Hospitals

Adult Day Health Centers

Chemical Dependency Recovery Hospitals

Congregate Living Health Facilities

Correctional Treatment Center

Intermediate Care Facilities

Intermediate Care Facilities/Developmentally Disabled

Intermediate Care Facilities/Developmentally Disabled – Habilitative

General Acute Care Hospitals

Pediatric Day Health and Respite Care Facilities

Primary Care Clinics

Psychology Clinics

Skilled Nursing Facilities

What to Report:

Public Safety Power Shutoff (PSPS) power outages

Generator and fuel status (number of days/supply of fuel currently available and plans for obtaining more fuel or evacuating if necessary)

Any impact on patients

Any resource needs

Where to Report:

The California Department of Public Health (CDHP)

Licensing and Certification (L&C) Program

Local L&C district office (DO)

Local Public Health Officer

Medical Health Operational Area Coordinator (MHOAC)

For additional information on AFL 19-30.1, access the DHCS website at:

https://www.cdph.ca.gov/Programs/CHCQ/LCP/CDPH%20Document%20Library/AFL-19-30.1.pdf

BEHAVIORAL HEALTH INTEGRATION GRANTS:

Proposition 56: Value Based Payment Program

Eureka | Fairfield | Redding | Santa Rosa

(707) 863-4100 | www.partnershiphp.org

November 2019

The California Department of Health Care Services (DHCS) recently announced it is accepting

applications for Behavioral Health Integration grants. Eligible applicants must have a contract

with Partnership HealthPlan of California (PHC) (or with Beacon Health Options on behalf of

PHC). Below is a brief summary of the purpose of the grant from DHCS. PHC will be providing

additional information on our roles and perspectives in the near future. We encourage all eligible

providers to apply.

As stated by DHCS: “The objective of the DHCS Behavioral Health Integration (BHI) Incentive

Program is to incentivize plans to improve physical and behavioral health outcomes, care delivery

efficiency, and patient experience by establishing or expanding fully integrated care in a Medi-Cal

managed health care plan’s (MCP) network, using culturally and linguistically appropriate teams

with expertise in primary care, substance use disorder conditions, and mental health conditions

who deliver coordinated comprehensive care for the whole patient.”

DHCS is hosting a webinar on Friday, November 22, 2019 at 1p.m.

To access the application and webinar information click the link below

https://www.dhcs.ca.gov/provgovpart/Pages/VBP_BHI_IncProApp.aspx

Applications are due to PHC on January 21, 2020.

Additional updates are forthcoming.

Proposition 56:

Supplemental Reimbursement for Family Planning,

Access, Care, and Treatment (Family PACT)

Eureka | Fairfield | Redding | Santa Rosa

(707) 863-4100 | www.partnershiphp.org

November 2019

In November 2016, California voters passed Proposition 56 also known as the California Healthcare, Research, and Prevention Tobacco Tax Act. Beginning April 2017, Prop. 56 imposes a $2 tax per pack of cigarettes and a proportional tax on other nicotine products. The proposition allocates money for many things, but a large percentage is earmarked to support Medi-Cal providers.

While the proposition itself does not have a sunset date, expenditure methods are for defined periods, as set by the state Legislature and Centers for Medicare and Medicaid Services (CMS).

The Family Planning, Access, Care, and Treatment (Family PACT) Program will continue to provide time-limited supplemental payments to Family PACT providers for Evaluation and Management (E&M) office visits rendered for comprehensive family planning services for the period of July 1, 2019 through December 31, 2021.

Prospective Payment Systems (PPS) providers are not eligible for the Family PACT incentives.

For more information on Prop 56 and Family PACT, access the DHCS website below:

https://www.dhcs.ca.gov/services/Pages/Proposition-56-FPACT.aspx

Updated Facility Site Review

Policy for OB Sites

Eureka | Fairfield | Redding | Santa Rosa

(800) 863-4155 | www.partnershiphp.org

November 2019

IMPORTANT INFORMATION:

In the past, Partnership HealthPlan of California (PHC) conducted a Facility Site Review with no

follow-up reviews when an Obstetrician/Gynecological (OB) practice contracted with PHC. In

one of multiple efforts to improve Quality, PHC will now begin conducting Site Reviews for OB

sites with the same periodicity as with our Primary Care Providers (PCPs). This means that

PHC will be conducting Site Reviews at OB sites, both the Facility portion and the Medical

Record portion, every three years at a minimum.

PHC will be spacing the reviews for the OB providers out over the next few years and will

contact each provider site directly. Some sites will be contacted in the near future and others

may not be contacted for another year or two. PHC will give the providers plenty of notice in

scheduling visits and will be sending providers, all the criteria in advance, so that sites can be

prepared.

To access the updated policy, visit the PHC website at www.partnershiphp.org and enter

MPQP1022 in the search box. Providers can download and review the updated policy.

Please contact Tegan Spencer at tspencer@partnershiphp.org for questions about the updated

policy.

Eureka | Fairfield | Redding | Santa Rosa

(707) 863-4100 | www.partnershiphp.org

QUARTERLY REMINDERS

OCTOBER 2019

Relocation/Closing Steps to Notifying PHC

• Provider offices must notify PHC at a minimum of 90 days prior to contract terminations, site relocation, closures, addition or joining another organization. This also applies to physicians/practitioners that leave or are new to your office.

• Failing to report changes and/or moves can result in Authorization issues and non-payment of claims.

• Complete the PHC Provider Information Change Form and submit to PHC.

• You will need to submit the applicable change form to Department of Health Care Services also.

Scheduling Access Standards Primary Care Providers (PCPs):

Preventive Care - Within 10 business days Routine Care - Within 10 business days Urgent Care - Within 48 hours Emergent visit - Immediate treatment or referral to an appropriate emergency services provider Same day appointments - Open access appointments available same day or advanced access appointment scheduling if patient prefers Newborn Care - Newborns discharged from hospital in less than 48 hours after delivery should be seen within 48 hours of discharge Prenatal Care - Within 10 business days Specialists:

Specialty Care - Within 15 business days Urgent Care - Within 48 hours

Access to Interpretation

PHC provides telephone interpretive services for PHC members with limited English proficiency. Providers may access Language Line Services 24 hours a day. For PHC members: 1. Log on to PHC Provider Portal at

www.partnershiphp.org/UI/Login.aspx 2. In the right corner, click on Telephone

Interpretation Services, under your login name. Another window will open and information that includes the telephone number to call, Client ID number and a 4-digit access code.

3. An interpreter will be connected to the call. Brief the interpreter about the type of visit/service. Summarize what you wish to accomplish and any special instructions.

Member/Provider Face-To-Face Interpretive Services PHC will only pay for face-to-face interpreters for special situations:

Services for hearing impaired members

Complex courses of therapy or procedures Prior authorization via telephone is required. Contact PHC Member Services at 707-863-4120 or 800-863-4155 to request a face-to-face interpreter.

Each quarter the Department of Health Care Services (DHCS) may call to ask your staff the following information.

The information below is a reminder for your staff about Partnership HealthPlan of California’s (PHC) policies and

procedures.

Contracted with Medi-Cal Your office may be surveyed by DHCS to verify if your practice is a PHC provider. Please review with your staff, including call centers, Medi-Cal and PHC participants.

Languages spoken in Provider Office Your office may be surveyed for which languages are spoken in your office. Please ensure that your staff is aware of the languages spoken in your office.

For more information on these reminders, please contact

your Provider Relations Representative or visit

www.Partnershiphp.org/Providers/Pages/default.aspx

PROPOSITION 56:

Value Based Payment Program Overview

Eureka | Fairfield | Redding | Santa Rosa

(707) 863-4100 | www.partnershiphp.org

November 2019

In November 2016, California voters passed Proposition 56 also known as the California

Healthcare, Research and Prevention Tobacco Tax Act. Beginning April 2017, Prop. 56

imposed a $2 tax per pack of cigarettes and a proportional tax on other nicotine products. A

large percentage of the money is earmarked to support Medi-Cal providers.

While the proposition itself does not have a sunset date, expenditure methods are for defined

periods, as set by the California Legislature and Centers for Medicare and Medicaid Services

(CMS).

In July 2019, the Department of Health Care Services (DHCS) announced a Value-Based

Payment Program (VBPP) that will provide incentive payments to qualifying providers for

meeting specific measures aimed at improving care. These incentive payments will be targeted

to meet specific metrics targeting these areas:

Prenatal/Post-Partum Care

Early Childhood Preventive Care

Chronic Disease Management

Behavioral Health Integration (Beginning 1/1/20)

In total, there are 17 measures, and nine of them align with 2019 HEDIS measures. Three

measures are aligned with future 2020 clinical quality measures. Please see the table below

for the list of measures and which providers are eligible.

Payments are based on Medi-Cal having the encounter data, and there is an add-on bonus for

incentivized services rendered to patients with a code for homelessness, substance use

disorder or serious mental illness.

Encounters occurring at Federally Qualified Health Centers (FQHCs), Rural Health Clinics,

American Indian Health Clinics, or Cost Based Reimbursement Clinics will be excluded from

payment.

For more information visit the DHCS website at:

https://www.dhcs.ca.gov/provgovpart/Pages/VBP_Measures_19.aspx

.

PROPOSITION 56:

Value Based Payment Program Overview

Eureka | Fairfield | Redding | Santa Rosa

(707) 863-4100 | www.partnershiphp.org

Value Based Payment Program Details

Brief Description

17 Measures in the set, nine of the measures align with 2019 HEDIS

measures and three measures aligned with future 2020 clinical quality

measures.

Add-on bonus for incentivized services rendered to patients with a code for

substance use disorder, serious mental illness or homelessness (Z59.0 and

Z59.1).

Program Measures:

Prenatal/Postpartum Care

Early Childhood Measures

Chronic Disease Management

Behavioral Health (1/1/20)

Encounters occurring at Federally Qualified Health Centers (FQHCs), Rural

Health Clinics, American Indian Health Clinics or Cost Based Reimbursement

Clinics will be excluded from payment.

Providers likely to participate : PCPs, OB/GYNs, Cardiologists, Allergy Pulmonary,

Endocrine, Family Planning, Eligible Beacon (Clinicians; Pharmacists)

Service Codes

Prenatal

Pertussis

Payment to rendering or prescribing provider for Tdap vaccine (CPT 90715) with and ICD-10 code for pregnancy supervision (‘O09’ or ‘Z34’ series) anytime in the measurement year. Payment may only occur once per delivery per patient.

Prenatal Care Visit

First trimester prenatal visit. ICD-10 code for pregnancy

supervision: (‘O09’ or ‘Z34’ series) must be used day of visit.

Post-Partum Care Visits Early: 1-21 days Late: 22-84 days

A postpartum visit on or between one and 21 days after delivery;

and a postpartum visit on or between 22 and 84 days after

delivery. ICD-10 code for postpartum visit: Z39.2.

Postpartum Birth

Control

Provision to the most effective method, moderately effective

method, or long-acting reversible method of contraception within

60 days of delivery. Tables CCP-C through CCP-D at:

https://www.medicaid.gov/license-

agreement.html?file=%2Fmedicaid%2Fquality-of-

care%2Fdownloads%2F2019-adult-non-hedis-value-set-

directory.zip

PROPOSITION 56:

Value Based Payment Program Overview

Eureka | Fairfield | Redding | Santa Rosa

(707) 863-4100 | www.partnershiphp.org

Service Codes

Well-Child Visits

in first 15

months of life

Any of the following ICD-10: Z0000, Z0001, Z00110, Z00111,

Z00121, Z00129, Z005, Z008, Z020, Z021, Z022, Z023, Z024,

Z025, Z026, Z0271, Z0279, Z0281, Z0282, Z0283, Z0289, Z029

Well-Child Visits in third to sixth years of life

Any of the following ICD-10: Z0000, Z0001, Z00110, Z00111,

Z00121, Z00129, Z005, Z008, Z020, Z021, Z022, Z023, Z024,

Z025, Z026, Z0271, Z0279, Z0281, Z0282, Z0283, Z0289, Z029

All Childhood

Vaccines for 2-

Year-Olds

Payment to rendering provider for each final vaccine administered in a series to children turning two in the measurement year, must be recorded in CAIR2. Diphtheria, tetanus, pertussis (DTaP) – 4th vaccine Inactivated Polio Vaccine (IPV) – 3rd vaccine Hepatitis B – 3rd vaccine Haemophilus Influenzae Type b (Hib) – 3rd vaccine Pneumococcal conjugate – 4th vaccine Rotavirus – 2nd or 3rd vaccine Flu – 2nd vaccine

Blood Lead

Screening

Each occurrence of CPT code 83655 prior to or on a pat ients

second birthday. Must record in CDPH Blood Lead Registry.

Dental Fluoride

Varnish

Each occurrence of dental fluoride varnish (CPT 99188 or CDT

D1206) for children under age six.

Controlling High

Blood Pressure

A visit for controlled blood pressure must include: a code for controlled systolic – CPT 3074F or CPT 3075F. a code for controlled diastolic – CPT 3078F or CPT 3079F. a diagnosis of hypertension on the same day – ICD-10: I10.

Diabetes Care Payment that shows the results for members 18 to 75 years as coded with: CPT 3044F most recent HbA1c < 7.0% CPT 3045F most recent HbA1c 7.0-9.0% CPT 3046F most recent HbA1c > 9.0% No more than four payments per year, at least 60 days apart.

Tobacco Use

Screening

Payment to rendering provider for any of the following CPT codes:

99406, 99407, G0436, G0437, 4004F, or 1036F (equivalent

payment for all codes).

Adult Influenza

(Flu) Vaccine

Payment to rendering or prescribing provider for up to two flu shots

given throughout the year for patients aged 19 and older at the time

of flu shot.

PROPOSITION 56:

Value Based Payment Program Overview

Eureka | Fairfield | Redding | Santa Rosa

(707) 863-4100 | www.partnershiphp.org

Service Codes

Control of

Persistent

Asthma

Screening

Asthma Value set: J45.20 Mild intermittent asthma, uncomplicated J45.21 Mild intermittent asthma with (acute) exacerbation J45.22 Mild intermittent asthma with status asthmaticus J45.30 Mild persistent asthma, uncomplicated J45.31 Mild persistent asthma with (acute) exacerbation J45.32 Mild persistent asthma with status asthmaticus J45.40 Moderate persistent asthma, uncomplicated J45.41 Moderate persistent asthma with (acute) exacerbation J45.42 Moderate persistent asthma with status asthmaticus J45.50 Severe persistent asthma, uncomplicated J45.51 Severe persistent asthma with (acute) exacerbation J45.52 Severe persistent asthma with status asthmaticus J45.901 Unspecified asthma with (acute) exacerbation J45.902 Unspecified asthma with status asthmaticus J45.909 Unspecified asthma, uncomplicated J45.990 Exercise induced bronchospasm J45.991 Variant asthma J45.998 Other asthma

Screening for

Clinical

Depression

Payment to rendering provider for any of the following CPT codes for

screening for clinical depression: G8431 or G8510.

Must use a standardized screening tool and be an outpatient visit.

Management of

Depression

Medication

Major depression diagnosis codes – ICD-10: F32.0, F32.1, F32.2, F32.3,

F32.4, F32.9, F33.0, F33.1, F33.2, F33.3, F33.41, and F33.9.

Screening for

Unhealthy

Alcohol Use

Payment to rendering provider for any of the following CPT codes: 99408,

99409, G0396, G0397, H0049, and H0050.