PRESENTED BY: OHSU HEALTH SERVICES TEAM Provider
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PRESENTED BY: OHSU HEALTH SERVICES TEAM Provider Network Meeting OHSU Health Services March 9, 2021 Services Agenda COVID-19 Vaccinations - Katrina McPherson, MD and Dorane Brower, Chief Administrative Officer Quality Performance Update
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01
PRESENTED BY:
OHSU HEALTH SERVICES TEAM Provider Network Meeting OHSU Health Services
March 9, 2021 Services<br>
OHSU HEALTH SERVICES TEAM Provider Network Meeting OHSU Health Services
March 9, 2021 Services<br>
02
Agenda COVID-19 Vaccinations - Katrina McPherson, MD and Dorane Brower, Chief Administrative Officer
Quality Performance Update – Jennifer Johnston, MPH
Operations Update – Johnathan Ladd
CICP Update – Maggie Klein, RN, MSN, JD
Provider Relations Update – Lorna Filotei, Amanda Dunham, Kari Gothro
Q&A 2<br>
Quality Performance Update – Jennifer Johnston, MPH
Operations Update – Johnathan Ladd
CICP Update – Maggie Klein, RN, MSN, JD
Provider Relations Update – Lorna Filotei, Amanda Dunham, Kari Gothro
Q&A 2<br>
03
COVID-19 Vaccinations Katrina McPherson, MD - Chief Medical Officer
Dorane Brower - Chief Administrative Officer<br>
Dorane Brower - Chief Administrative Officer<br>
04
Overview of COVID-19 vaccination Complex system of coordination between public health, health systems, community organizations, CCO’s and others
Two distinct workstreams emerging
Herd immunity via mass vaccination sites
Technology (access/knowledge)
Transportation
Language
Mobility
Equity via collaborative approach with communities 4<br>
Two distinct workstreams emerging
Herd immunity via mass vaccination sites
Technology (access/knowledge)
Transportation
Language
Mobility
Equity via collaborative approach with communities 4<br>
05
Refresh of COVID-19 high-risk list
High risk medical conditions
BIPOC communities
Outreach being facilitated with 4th year Medical Students through SDOH course
Outreach focus areas:
Current clinical status and SDOH needs
Health-related Services referrals as indicated
Vaccine hesitancy with education
Vaccine access and plan for being scheduled
Referral to care coordination/case management 6 High Risk Outreach<br>
High risk medical conditions
BIPOC communities
Outreach being facilitated with 4th year Medical Students through SDOH course
Outreach focus areas:
Current clinical status and SDOH needs
Health-related Services referrals as indicated
Vaccine hesitancy with education
Vaccine access and plan for being scheduled
Referral to care coordination/case management 6 High Risk Outreach<br>
06
Medicaid Vaccine Workgroup Participants
Health systems (OHSU, Legacy, Kaiser, Providence) and CareOregon, Local Public Health Authorities and others
Goals
Supports for vaccine access related to language and cultural needs
Align strategies outreach and coordinated communications
Tracking vaccination rates
Data analytics and dashboard development
Standardized health and social determinant risk factors
Overlay vaccination data from ALERT system to view actual disparities
Identify supports needed by specific groups
Community partnerships 7<br>
Health systems (OHSU, Legacy, Kaiser, Providence) and CareOregon, Local Public Health Authorities and others
Goals
Supports for vaccine access related to language and cultural needs
Align strategies outreach and coordinated communications
Tracking vaccination rates
Data analytics and dashboard development
Standardized health and social determinant risk factors
Overlay vaccination data from ALERT system to view actual disparities
Identify supports needed by specific groups
Community partnerships 7<br>
07
Disparity-Based Outreach Utilize data from Health Share, Epic, Oregon ALERT immunization database
Within eligible populations identified by the state, further stratify based on potential for disparities
Race / Ethnicity / Language
High risk medical conditions
Social determinants of health (transportation)
Monitor near-real time vaccination rates for IDS Medicaid population
Identify emerging inequities in vaccination rates
Provide supports, messaging and outreach
Health plan care managers
PCPs
Community based organizations (culturally and linguistically specific) 8<br>
Within eligible populations identified by the state, further stratify based on potential for disparities
Race / Ethnicity / Language
High risk medical conditions
Social determinants of health (transportation)
Monitor near-real time vaccination rates for IDS Medicaid population
Identify emerging inequities in vaccination rates
Provide supports, messaging and outreach
Health plan care managers
PCPs
Community based organizations (culturally and linguistically specific) 8<br>
08
Quality Performance Update Jennifer Johnston, MPH
Manager, Clinical Value & Transformation<br>
Manager, Clinical Value & Transformation<br>
09
Medicaid (IDS) Quality Performance: Q1 Update 10<br>
10
Medicaid (IDS): Q1 Priorities Pediatric engagement and preventive care
Well Child Visits
Childhood Immunizations
Immunizations for Adolescents
Initiation and Engagement in Substance Use Disorder
HbA1c Poor Control (>9%)<br>
Well Child Visits
Childhood Immunizations
Immunizations for Adolescents
Initiation and Engagement in Substance Use Disorder
HbA1c Poor Control (>9%)<br>
11
Medicare (MSSP) Quality Performance Year End 2020 12<br>
12
Medicare (MSSP): 2021 Strategy Maintain performance on pay-for-performance metrics
HbA1c Poor Control (>9%)
Controlling High Blood Pressure
Falls: Screening for Future Risk
Flu Shots
Tobacco Use: Screening & Intervention
Transform Performance on 2022 metrics
HbA1c Poor Control (>9%)
Controlling High Blood Pressure
Depression Screening and Follow-Up<br>
HbA1c Poor Control (>9%)
Controlling High Blood Pressure
Falls: Screening for Future Risk
Flu Shots
Tobacco Use: Screening & Intervention
Transform Performance on 2022 metrics
HbA1c Poor Control (>9%)
Controlling High Blood Pressure
Depression Screening and Follow-Up<br>
13
Operations Update Johnathan Ladd – Provider Relations<br>
14
15 Claims Update OHSU Health Services is currently exceeding clean claim processing turnaround times:
97.44% of claims processed within 30 days
(goal is 90%)
99.18% of claims processed within 90 days
(goal is 99%)<br>
97.44% of claims processed within 30 days
(goal is 90%)
99.18% of claims processed within 90 days
(goal is 99%)<br>
15
PCP Member Roster Reconciliation OHSU HealthServices IDS sends out a monthly membership roster to each PCP clinic in the OHSU HealthServices network
It is the responsibility of each PCP clinic to validate and reconcile their monthly membership reports and notify us of any changes
Examples of when you should contact us:
Members that should be assigned, and are not
Members that are assigned, and should not be
We are currently working on a claim-based reconciliation workflow so that we can also assist in making sure PCP assignments are accurate and up to date<br>
It is the responsibility of each PCP clinic to validate and reconcile their monthly membership reports and notify us of any changes
Examples of when you should contact us:
Members that should be assigned, and are not
Members that are assigned, and should not be
We are currently working on a claim-based reconciliation workflow so that we can also assist in making sure PCP assignments are accurate and up to date<br>
16
Referrals and Auths 17 Referrals are required for:
Specialist office Visits that are below-the-line (BTL), non-funded or unlisted on DMAP’s Prioritized List of Covered services
Request for out-of-network specialist & ancillary providers<br>
Specialist office Visits that are below-the-line (BTL), non-funded or unlisted on DMAP’s Prioritized List of Covered services
Request for out-of-network specialist & ancillary providers<br>
17
Referrals and Auths Cont. 18 Referrals are not required for:
Primary Care office visits
Orthopedic Providers
Specialist office visits with an above-the-line (ATL) or funded Diagnosis code.
People with Special Health Care Needs (SHCN) or for OB/GYN, Orthopedic services and/or immunizations for in or out-of-network services
Individuals who have high health care needs, multiple chronic conditions, mental illness or substance use disorders; and either have functional disabilities or live with health or social conditions that place them at risk of developing functional disabilities. (for example, serious chronic illnesses or certain environmental risk factors such as homelessness or family problems that lead to the need for placement in foster care)<br>
Primary Care office visits
Orthopedic Providers
Specialist office visits with an above-the-line (ATL) or funded Diagnosis code.
People with Special Health Care Needs (SHCN) or for OB/GYN, Orthopedic services and/or immunizations for in or out-of-network services
Individuals who have high health care needs, multiple chronic conditions, mental illness or substance use disorders; and either have functional disabilities or live with health or social conditions that place them at risk of developing functional disabilities. (for example, serious chronic illnesses or certain environmental risk factors such as homelessness or family problems that lead to the need for placement in foster care)<br>
18
Special Healthcare Needs (SHCN) 19 We have created a monthly SHCN roster that we will be sending to all PCP clinics along with capitation data every month.
In addition to the SHCN roster, all clinics will be able to use the benefit tracker to identify if the member is SHCN. It will not indicate what the need is but can verify that no referrals are required.
We are currently working on a system that will allow providers to notify us of members they believe should be designated as SHCN.<br>
In addition to the SHCN roster, all clinics will be able to use the benefit tracker to identify if the member is SHCN. It will not indicate what the need is but can verify that no referrals are required.
We are currently working on a system that will allow providers to notify us of members they believe should be designated as SHCN.<br>
19
Second opinions OHSU Health Services provides a second opinion from a qualified healthcare professional within the network or arranges for members to obtain a second opinion outside the network at no cost to the member. The member or provider (on behalf of the member) contacts OHSU Health Services customer service to request a list of potential in network providers that can perform the second opinion.
Once a provider is chosen for the second opinion, a referral will be requested via the same process as any other referral, with the box marked “second opinion” checked on the referral and authorization form as seen at the top of this slide.
If a new diagnosis is reached with the new provider, the care may continue with new treatment plans by that doctor. If the same diagnosis is reached with the second opinion, the member may choose to seek another opinion or continue treatment plans with either doctor they saw.<br>
Once a provider is chosen for the second opinion, a referral will be requested via the same process as any other referral, with the box marked “second opinion” checked on the referral and authorization form as seen at the top of this slide.
If a new diagnosis is reached with the new provider, the care may continue with new treatment plans by that doctor. If the same diagnosis is reached with the second opinion, the member may choose to seek another opinion or continue treatment plans with either doctor they saw.<br>
20
New Email Distro 21 ohsuidsproviderinquiry@modahealth.com Available for:
All claims questions
General concerns<br>
All claims questions
General concerns<br>
21
Clinical Integration and Care Coordination Program Updates Maggie Klein RN, MSN, JD
Director, Care Integration & Care Coordination Program Services<br>
Director, Care Integration & Care Coordination Program Services<br>
22
COVID-19 Outreach High-risk outreach in partnership with OHSU 4th year Medical Students through the SDOH rotation
Outreach includes:
Discussion of current clinical status
COVID exposure and potential for Long COVID
SDOH Assessment, identification of needs and referral for Health-related Services
Plan for Vaccination – Access and Confidence in Vaccine
Referral to Care Coordination and Care Management
Medicaid Vaccine Workgroup Collaborations – across Health Share partner organizations
Efforts include:
Equitable distribution of vaccine
Vaccine to Home efforts for homebound 23<br>
Outreach includes:
Discussion of current clinical status
COVID exposure and potential for Long COVID
SDOH Assessment, identification of needs and referral for Health-related Services
Plan for Vaccination – Access and Confidence in Vaccine
Referral to Care Coordination and Care Management
Medicaid Vaccine Workgroup Collaborations – across Health Share partner organizations
Efforts include:
Equitable distribution of vaccine
Vaccine to Home efforts for homebound 23<br>
23
Health-Related Services (HRS) Established as a component of CCO 2.0
1115 Medicaid demonstration waiver for 2017–2022
HRS are non-covered services under Oregon’s Medicaid State Plan
Intended to improve care delivery and overall member and community health and well-being
Provides a funding mechanism to address the social determinants of health (SDOH) including the health-related social needs of their members 24<br>
1115 Medicaid demonstration waiver for 2017–2022
HRS are non-covered services under Oregon’s Medicaid State Plan
Intended to improve care delivery and overall member and community health and well-being
Provides a funding mechanism to address the social determinants of health (SDOH) including the health-related social needs of their members 24<br>
24
Health-related Services 25<br>
25
Health-Related Services Primary Focus – to address basic needs to improve Health Outcomes
Identified through Social Determinants of Health Assessment
Multiple domains assessed as component of Member Screening Assessment
Reimburses for services or devices that are non-billable with a positive ROI<br>
Identified through Social Determinants of Health Assessment
Multiple domains assessed as component of Member Screening Assessment
Reimburses for services or devices that are non-billable with a positive ROI<br>
26
HRS - Demographic Info General Demographic Health Related Services - Utilization<br>
27
Examples – Health-Related Services Hotel days for pre-procedural or post-surgical unsafely homed/homeless members, shelter vouchers, RCP stays
Air conditioners to help support clinical treatment plan
Smart phones, digital devices and internet access
Meals on wheels (short term), meal tickets, gift cards to help with groceries in addressing food insecurity, food boxes, and food scales
Utility payments and rental expense assistance
Duffel bags with a blanket and hygiene items for foster children 28<br>
Air conditioners to help support clinical treatment plan
Smart phones, digital devices and internet access
Meals on wheels (short term), meal tickets, gift cards to help with groceries in addressing food insecurity, food boxes, and food scales
Utility payments and rental expense assistance
Duffel bags with a blanket and hygiene items for foster children 28<br>
28
29 HRS Submission Process Contact Information:
General OHSU Health Services Care Team Email
OHSUHSCareTeam@ohsu.edu
HRS Submission Form
https://www.ohsu.edu/sites/default/files/2020-05/OHSU%20Health_Health%20Related%20Services%20Request%20Form_June.pdf
Maggie Klein – Care Integration and Care Coordination Program Director
kleimagg@ohsu.edu
Cell number: 503-789-5870<br>
General OHSU Health Services Care Team Email
OHSUHSCareTeam@ohsu.edu
HRS Submission Form
https://www.ohsu.edu/sites/default/files/2020-05/OHSU%20Health_Health%20Related%20Services%20Request%20Form_June.pdf
Maggie Klein – Care Integration and Care Coordination Program Director
kleimagg@ohsu.edu
Cell number: 503-789-5870<br>
29
Provider Relations Update Provider Relations Team<br>
30
To ensure high quality care is being provided to our members, Board Certification for MDs, DOs, and DPMs will be required for new and existing providers effective April 1, 2021.
Providers who have completed residency will have 5 years to become Board Certified. 31 Credentialing Policy Update<br>
Providers who have completed residency will have 5 years to become Board Certified. 31 Credentialing Policy Update<br>
31
If you have a provider that has let their Board Certification lapse please reach out to Lorna at Filotei@ohsu.edu. The provider will be allowed one year to renew the lapsed Board Certification. 32 Credentialing Policy Update<br>
32
Reach out to Care Management (CM) any time there is potential for a Member dismissal via phone 844-827-6572 or email:
OHSUHSCareTeam@ohsu.edu
CM will:
Gather information as to the reason or circumstances for the requested dismissal 33 Patient Dismissal Process<br>
OHSUHSCareTeam@ohsu.edu
CM will:
Gather information as to the reason or circumstances for the requested dismissal 33 Patient Dismissal Process<br>
33
Ask about steps taken to resolve the issue/ circumstance
Was the Clinic Care Manager involved or was there a referral to the ICCM (Integrated Community Care Managers) team for assistance in resolving the issue?
Are there issues of childcare, transportation, etc that are contributing factors that need to be addressed?
If so, how were these addressed?
What is the plan for continuity of care until the Member has been re-established? 34 Patient Dismissal Process<br>
Was the Clinic Care Manager involved or was there a referral to the ICCM (Integrated Community Care Managers) team for assistance in resolving the issue?
Are there issues of childcare, transportation, etc that are contributing factors that need to be addressed?
If so, how were these addressed?
What is the plan for continuity of care until the Member has been re-established? 34 Patient Dismissal Process<br>
34
Depending on the outcome of the questions, and/or if it has been determined there is a complete breakdown of the therapeutic relationship, the Care Integration and Care Coordination Program (CICP) team can assist the Member in selecting a new PCP.
This is a service CICP provides to Members not only at initial intake, but whenever they receive a request to help identify a new PCP. 35 Patient Dismissal Process<br>
This is a service CICP provides to Members not only at initial intake, but whenever they receive a request to help identify a new PCP. 35 Patient Dismissal Process<br>
35
36 Cultural & Diversity Training Reminder: Annual Compliance Attestation occurs once a year and is promoted during the Fall
Attestation is on behalf of staff and Provider(s)
Two items that require both staff and Provider participation - Fraud, Waste and Abuse
- Cultural Competence Training*.
*Cultural Training is a requirement noted in the IDS contract as well as required by providers’ licensing Boards.<br>
Attestation is on behalf of staff and Provider(s)
Two items that require both staff and Provider participation - Fraud, Waste and Abuse
- Cultural Competence Training*.
*Cultural Training is a requirement noted in the IDS contract as well as required by providers’ licensing Boards.<br>
36
37 Cultural & Diversity Training We will go into more detail at the next Provider Meeting. In the meantime….
We will forward mails re: Cultural Training as they come to our attention. NOTE: In sharing this information we are not advocating the training, as it is your personal choice to decide which training is best for your clinic.
We will forward the current list of OHA-Approved Cultural Competence Continuing Education Training (2/10/21) as a resource.<br>
We will forward mails re: Cultural Training as they come to our attention. NOTE: In sharing this information we are not advocating the training, as it is your personal choice to decide which training is best for your clinic.
We will forward the current list of OHA-Approved Cultural Competence Continuing Education Training (2/10/21) as a resource.<br>
37
38 Timely Access Timely access ensures our members’ needs are being taken care of and are based on regulatory standards. Providers are to make necessary and appropriate arrangements to provide care for their members based on the urgency of the service.
The following guidelines should be standard practice.
Survey
Sources: Network Participant Agreement Addendum 2-A CCO Participation Requirements
Provider Manual, Responsibilities of PCP, pg. 22<br>
The following guidelines should be standard practice.
Survey
Sources: Network Participant Agreement Addendum 2-A CCO Participation Requirements
Provider Manual, Responsibilities of PCP, pg. 22<br>
38
39 Timely Access Sources: Network Participant Agreement Addendum 2-A CCO Participation Requirements
Provider Manual, Responsibilities of PCP, pg. 22, AS-100 IDS Member Access to Care Policy.<br>
Provider Manual, Responsibilities of PCP, pg. 22, AS-100 IDS Member Access to Care Policy.<br>
39
40 Timely Access Survey:
Does your clinic schedule routine appointments within
4 weeks? Yes or No
Does your clinic schedule urgent visits within 72 hours?
Yes or No<br>
Does your clinic schedule routine appointments within
4 weeks? Yes or No
Does your clinic schedule urgent visits within 72 hours?
Yes or No<br>
40
Translation Services Alternate forms of communication are provided, free of charge, to all members who do not speak English as a primary language or who have sensory impairments.
A list of OHSU Health Services contracted interpreter services is on the next slide. Source: Provider Manual, pg 32<br>
A list of OHSU Health Services contracted interpreter services is on the next slide. Source: Provider Manual, pg 32<br>
41
Translation Services<br>
42
Providers may choose to coordinate interpretation services themselves instead of through OHSU Health Services, however, the Provider will be responsible for paying for interpretation services. OHSU Health Services only pays for interpretation services that are coordinated through our preferred vendors. 43 Translation Services Source: Provider Manual, pg 32<br>
43
Questions & Answers OHSU Health Services Team<br>
44
Thank you for all the good work you do for our community! Services<br>