NEPHO NEWS
August 2018 (click here for pdf version)
OPTUM Insider Newsletter: August Focus – Vision Impairment
PHYSICIAN and PRACTICE CHANGES/UPDATES
New Physicians
- Neil Denbow, MD has joined Beverly Radiological Associates, 85 Herrick Street,
Beverly, MA 01915 978-922-3000 (F) 978-927-3534 - Kathryn Hollett, MD has joined Lahey Health, Primary Care, Gloucester 298 Washington Street 1st Floor,
Gloucester, MA 01930 978-283-2726 (F) 978-283-0840 - Andrew Lenhardt, MD has joined Lahey Health, Primary Care, Beverly, 900 Cummings, Suite 111 W,
Beverly, MA 01915 978-927-1859 (F) 978-927-2388 - Jana Oettinger, MD has joined Family Medicine Associates, A Member of Lahey Health 195 School Street,
Manchester, MA 01944 978-526-4311 (F) 978-525-2342 - Reuben Shin, MD has joined Essex Surgical Associates 100 Cummings Center, Suite 112D, Beverly, MA 01915
978-922-9226 (F) 978-922-9203 - Joan Tryzelaar, MD has joined The Wound and Hyperbaric Center, 500 Cummings, Suite 1800, Beverly, MA 01915 978-921-1210 (F) 978-921-1534
Physician/Practice Changes
- Effective 8/15/2018, Chieh-Min Fan, MD of Beverly Radiological Associates has terminated her affiliation with
the Northeast PHO. - Effective 9/1/2018, Robert Tufts, MD will be opening a Sleep Clinic located at Lahey Outpatient Center, Danvers,
480 Maple Street, Danvers, MA 01923 978-921-1717 (F) 978-922-5382. - Effective 10/29/2018, Mauri Cohen, MD and Loretta Bergesen, NP of Lahey Health Primary Care, Danvers of
140 Commonwealth Ave, Danvers, MA 01923 will be relocating to 5 Federal Street Danvers, MA 01923.
SAVE THE DATE
Office Manager Meeting – Guest Speaker: Heather Lawson – Tufts Health Plan
Date: September 12, 2018 @12:00 Noon
Place: 500 Cummings Center, Suite 6500
Good Harbor Conference Room
Beverly, MA 01915
RSVP: Judith O’Learyat Judith.O’Leary@Lahey.org or 978-236-1739
NP PA Meeting – Guest Speaker: Dr. Michael Indelicato – Arthritis Associates, Inc.
Date: September 21, 2018 @12:00 Noon
Place: 500 Cummings Center, Suite 6500
Good Harbor Conference Room
Beverly, MA 01915
RSVP: Judith O’Learyat Judith.O’Leary@Lahey.org or 978-236-1739
MD Orientation
Date: September 26, 2018 @5:30 P.M.
Place: 500 Cummings Center, Suite 6500
Good Harbor Conference Room
Beverly, MA 01915
RSVP: Alycia Messelaar at Alycia.Messelaar@Lahey.org or 978-236-1784
IPA / POD MEETING SUMMARIES
Efficiency: Pharmacy
Carol Freedman RPh, NEPHO Manager of Pharmacy Services, introduced Patrick McCarthy, the new ACO pharmacist and reviewed the process for referring patients to Patrick. Carol also provided lists of patients on sildenafil with cost savings opportunities and offered to outreach to patients as directed by the provider.
Reporting
Dr. Di Lillo, Medical Director, reviewed the updated meeting attendance report and the first Quarter PCP Risk Sharing Report Card.
Quality Update
Liz Isaac, Director of Quality and Performance Improvement, provided an update on 2018 AQC Quality performance and reviewed a checklist of actions that practices can be taking now to maximize their quality score:
- Continue prioritizing college age kids for Well Child visits and Chlamydia screens. Well Child visits are based on calendar year, not on a 365 day calendar and must be completed in 2018.
- Order overdue Hemoglobin A1C’s within the next month so that necessary med adjustments can be made; the health plan target is Hemoglobin A1C of 9.0 or less.
- Schedule pap smears for patients on the Cervical Cancer screening list.
- Offer FIT tests (or Cologuard) to patients on the Colon Cancer screening list if they are reluctant or unable to schedule a colonscopy.
- Schedule follow up visits and/or prescribe controller medication as warranted for patients on your Asthma Medication list who are over-utilizing reliever medications.
- Check your PHQ-9 list of patients to schedule a date for follow up screening 3-12 months after initial high score. Document both scores in the chart.
Efficiency: Coding
Alison Gustafson, NP Population Health, reviewed findings from a chart audit for long term insulin:
- 75% of charts reviewed (n =264) were appropriately coded for long term insulin use.
- Final impact of missed diagnosis from this audit alone is ~$60K loss from health plan budget that is provided to take care of these patients.
- Coding for “Diabetes with Hyperglycemia” any time the Hemoglobin A1C is not at goal adds $1600 to the budget provided to take care of a patient with diabetes.
- Coding for each diabetes associated complication also adds significantly to the budget provided to take care of a patient with diabetes.
- Related to improving coding: Epic EMR providers will now see new Best Practice Advisories that will alert providers when patients have:
- Hemoglobin A1C equal to or greater than 6.5 and no diabetes diagnosis or
- Diagnosis of diabetes with Hemoglobin A1C greater than or equal to 9
Informational
- Dr. Di Lillo provided an update on new providers and transitions.
- The 2019 POD meeting calendar was reviewed at each POD for changes due to holidays etc.
DIABETES CARE CENTER UPDATE: REF222 / LMI Programs
REF222, the Epic physician order for the Diabetes Care Center at Lahey Outpatient Center, Danvers and
Addison Gilbert Hospital, has been updated for ease of use!
Less clicks and now compliant = no more paper orders!
Have questions? Please contact Pat Ferreira, RN-CDE, CCRC, Clinical Administrator, LMI/Medical Specialtiesat patricia.a.ferreira@lahey.
REF222 Danvers Diabetes Referral (CMS)
(click screen shot to enlarge/print) 
(click screen shot to enlarge/print) 
Add to Favorites:
Epic Referral numbers to our programs:
- REF111 Ambulatory referral to Danvers Anticoagulation Clinic
- REF222 Ambulatory referral to Danvers Diabetic Clinic
- REF223 Ambulatory referral to Danvers Cardiac Rehabilitation
- REF225 Ambulatory referral to Danvers Pulmonary Rehabilitation Clinic
- REF226 Ambulatory referral to Danvers Weight Management
- REF227 Ambulatory referral to Danvers Risk Reduction
- REF50 Ambulatory referral to Danvers Medical Nutrition Therapy
- REF101 Ambulatory referral to Danvers Bariatric Surgery (Surgical Weight Loss)
- REF101 Ambulatory referral to Tobacco Treatment
PHARMACY UPDATES
Pharmacy Update:
NEPHO would like to welcome Patrick McCarthy, Pharm D, Clinical Pharmacy Specialist for Population Health in the Medicare ACO. Pat is a graduate of MCPHS University in Boston, and just completed a Post-Graduate Year 1 (PGY1) pharmacy residency program at Atrius, where he has been collaborating with providers in pharmacotherapy management for various populations in the ambulatory care setting. In his role as a Medicare ACO pharmacist, Pat will be performing comprehensive medication reviews for high-risk patients or complex patients with chronic disease states. Carol Freedman, RPh, BCGP will continue to provide similar pharmacy services for NEPHO Commercial patients. We welcome your patient referrals!
Referrals from providers can be made to either Patrick or Carol through Epic In-Basket or as noted below. Please see the attached for more information on LCPN pharmacy resources.
Patrick McCarthy, Pharm D 978-236-1646 or Patrick.McCarthy@Lahey.org
Carol Freedman, RPh, BCGP 978-236-1774 or Carol.Freedman@Lahey.org
Valsartan Recall Update:
On July 13th of this year the FDA initiated a series of announcements regarding the recall of certain batches of valsartan and valsartan-hydrochlorothiazide (HCTZ) tablets because they may contain the impurity N-nitrosodimethylamine (NDMA). NDMA is classified as a probable human carcinogen by the U.S. Environmental Protection Agency. The presence of NDMA was unexpected in the recalled valsartan products and is thought to be related to changes in the way the active substance was manufactured. See the attached updated FDA list of valsartan products currently under recall as of August 9, 2018.
Please contact Carol Freedman, Manager Pharmacy Services, for more information at Carol.Freedman@Lahey.org or
978-236-1774
POPULATION HEALTH
Update:
Currently Lucia Kmiec, NEPHO Health Coach, is working on concierge-scheduling Mammograms for all AQC patients who are due for a Mammograms. Lucia is calling the patients who have no Mammography reports on their EMR or have no history of Mammogram Screenings. In addition, letters have been sent to those patients who have refused Mammograms to let them know she can schedule their screening if/when they are ready for it.
For those providers using EPIC please keep in mind that the “Mammo Bilateral Screening” order can no longer be used to schedule Mammograms. The correct order is: “Mammo Screening Tomosynthesis Bilateral”.
Please contact “Lucia Kmiec, PHO Health Coach, at Lucia.kmiec@lahey.org or 978-880-2318 if you have any questions or concerns!
QUALITY
2018 Quality Measures on the Move!
Due to your ongoing efforts on the patient lists you receive monthly, we have already reached the minimum and maximum thresholds set by BCBS for a few of the quality measures. The minimum threshold of each measure must be reached to earn credit for the measure. When the maximum threshold is reached for a measure, the maximum available points for that measure is attained (max points = 5 for most measures).
Acute Bronchitis
- 2 out of 3 patients with acute bronchitis did not receive antibiotics, exceeding the minimum threshold of 55%.
- The maximum threshold for this measure is attained when at least 80% of patients with acute bronchitis are
not prescribed. - To keep this measure on track, please continue to code for acute bronchitis as appropriate, and prescribe therapy
(not antibiotics) for symptoms.
Asthma Medication Ratio
- 88% of patients in this measure are in compliance, which exceeds the maximum threshold of 86% and is currently earning the maximum points = 5.
- One best practice that has been discussed in meetings is to prescribe a controller at the same time when
a reliever medication is being refilled.
3 Month (Acute Phase) Depression Medication Compliance
- 63% of patients in this measure are in compliance (minimum threshold = 60%), meaning that they have refilled their antidepressant medication consistently for 3 months.
- The maximum threshold for this measure is only set at 75%, which indicates the difficulty of this measure.
- Continue encouraging your patients in this measure to let you know if they are experiencing difficulty with their antidepressants, in order to provide options early as warranted.
Imaging in Low Back Pain
- 89% of patients in this measure were diagnosed with low back pain and did not have imaging ordered, which meets the maximum threshold and earns maximum points (5) for this measure.
- Continue coding for low back pain as appropriate, prescribing alternatives to imaging in the first month after diagnosis.
Controlling High Blood Pressure
- 77% of patients with hypertension are at goal BP as of now, which just exceeds the minimum threshold
of 76%. - In order to reach the minimum threshold of 91.9%, at least 128 more patients need to reach goal blood pressure
by year end. - Overall, there are almost 200 patients in this measure who are outside of their target blood pressure.
PAYOR UPDATES
BMC HealthNet Qualified Health Plan Contract
Boston Medical Center HealthNet (BMCHP) offers multiple Qualified Health Plan (QHP) products. The Northeast PHO contract is for the QHP-Silver product only.
Our contract does not include the BMCHP QHP Bronze, Gold and Platinum product. Please be sure to check the patients’ eligibility to verify you are a participating provider for their health plan coverage.
Please note: If you practice has a direct contract with
BMCHP for additional plans, please refer to your contract.
As a reminder, the Northeast PHO health plan participation is on our website and can be found by clicking this link:
https://www.nepho.org/wp-content/uploads/2018/04/Plan-Participation-Grid-2018.pdf
Learn how to check member eligibility on the BMC provider portal by clicking the following link: https://www.bmchp.org/I-Am-A/Provider/Training-and-Support
Visit bmchp.org and click Provider Login.
Log In to the Provider Portal on the Please Sign In page, login to the portal using your User ID and Password. You should have received either hard copy or electronic instructions from your office administrator who added you as a user. The information will include a user ID and temporary password. Once you have logged in using the temporary password, please update your password.
Verify Member Eligibility
1. Search Patient
2. Check Patient Eligibility
For your convenience, there is a shortcut on the portal’s home screen, so you can quickly check a member’s eligibility status. On the Conduct Eligibility Search page, select search criteria and click Search.
Search criteria can be:
a) the desired patient search criteria: Name or Member ID or
b) Enter the appropriate patient information in the search field. Change the As of Date if you want
eligibility information for a date prior to today’s date.
3. Search displays members matching your search criteria. Click the member’s name to choose which member for which you would like eligibility information.
Fallon Health
Operative Note Review Process Discontinued
Effective 05/01/2018 – Reimbursement, Authorization/PreCertification
The Operative Note review process was discontinued, and providers are no longer required to send in documentation for professional claims over $1,000 or facility claims over $5,000. If the provider’s office has a third party biller, please alert them to this change. To view the notification, click on the link below and turn to page 5. Please refer to the Fallon newsletter (July 2018) for this update as well as other coverage and prior authorization updates.
Fallon Connection Newsletter/July
Harvard Pilgrim Health Care
New Online Behavioral Health Pilot Program
Effective 07/01/2018 – Administrative, Clinical
Harvard Pilgrim is launching a pilot with AbleTo, a structured eight-week online health program that connects commercial members with a professional therapist and coach. The program is aimed at helping members dealing with a medical condition or life stressor develop tools to manage stress and anxiety, improve mood and outlook, cope with a health issue, and overcome barriers to making a positive change. For additional information, click on the link below. Posted to Network Matters, July 2018.
https://www.harvardpilgrim.org/portal/page?_pageid=253,12050111&_dad=portal&_schema=PORTAL
Harvard Pilgrim Health Care
Hierarchical Condition Categories Coding Reminders
Effective 07/01/2018 – Clinical, Reimbursement
Thorough reporting by physicians is essential to maintaining accurate medical records. When reporting medical care for patients with complex conditions, it is important to emphasize correct documentation and to focus on hierarchical condition categories (HCC) coding. HCCs are a set of broad conditions (for example, asthma or congestive heart failure) into which diagnosis codes are grouped under Medicare and the Affordable Care Act’s risk adjustment model. The reporting of HCCs must be based on clinical medical record documentation from a face-to-face encounter. HCCs should be captured at least once every 12 months. For additional information, click on the link below. Posted to Network Matters, July 2018.
https://www.harvardpilgrim.org/portal/page?_pageid=253,12050276&_dad=portal&_schema=PORTAL
Harvard Pilgrim Health Care
Voluntary Home Infusion Program for Remicade and IVIG
Beginning on Sept. 1, Harvard Pilgrim will be offering a voluntary home infusion program for infliximab and immunoglobulin (IVIG) treatment in conjunction with Coram CVS Specialty Infusion Services. If any of your Harvard Pilgrim members are administered these medications in an outpatient setting, you and the patient may receive a letter or phone call from a CVS/Coram clinical care team member to discuss the possibility of having the patient receive home infusion services.
Since many patients prefer receiving infusion services in the comfort of their home, this voluntary program offers our members added convenience, and is cost-effective.
The medical drugs included in this voluntary program are:
- Infliximab — Remicade, Inflectra, Renflexis
- IVIG — Bivigam, Carimune, Flebogamma, Gammagard Liquid, Gammagard S/D, Gammaked,
Gammaplex, Gamunex-C, Octagam, and Privigen
How the program works
CVS/Coram will contact patients receiving these medications to determine if they are interested in home infusion services. If so, the CVS/Coram clinical staff will contact the physician to review the member’s case and ensure that the patient is an appropriate candidate for in-home service. If the provider agrees, Coram will collaborate with the provider on the transition to home infusion, working together to obtain the necessary orders and making the therapy arrangements with the patient.
At the start of the program, a CVS/Coram care team member will perform a detailed initial clinical assessment for the medication and an introduction to Coram with the patient. The same nurse will be assigned for each visit with the patient; this consistency helps ensure that subtle changes in patient response to treatment can be identified over time. After each visit, Coram will provide the patient’s physician with a clinical report via fax or telephone, based on the physician’s preference.
Other home infusion providers may be used
While HPHC is working with CVS/Coram on outreach for this voluntary program, you may choose to use another home infusion provider. If you currently work with a home infusion provider for these or other medications, you can continue to do so. If you want to get a patient started with home infusion but would prefer to use a vendor other than Coram, contact Harvard Pilgrim’s Provider Service Center at 800-708-4414.
Prior authorization needed
Information about the program will be included in authorization determination letters after prior authorization has been granted, and phone calls to the member and physician will occur after that. HPHC will also send letters about this home infusion program to providers with patients who were authorized to receive these intravenous medications earlier in 2018, as well as to these patients.
As a reminder, the medical drugs included in this program require prior authorization from CVS Health—Novologix. For details on the prior authorization program for medical drugs, including criteria and prior authorization request forms, please refer to the Medical Drug Prior Authorization page on the HPHC provider website.
REFERRAL MANAGEMENT
Referral Pad Update
The Northeast PHO (NEPHO) Referral Department has updated our specialty “referral pads”. These pads are handy at the point-of-care when a referral to a specialist is needed. Simply tear off and give the ready-made list to your patients. The specialists’ contact information is included to facilitate scheduling a visit.
The updated referral pads were delivered to many of our physician practices. If you would like any referral pads for your practice, please contact Ann Cabral at ann.cabral@lahey.org or 978-236-1758.
- Asthma and Allergy
- Cardiology
- Dermatology
- ENT
- Gastroenterology
- General/Vascular Surgery
- Neurology
- Ophthalmology
- Orthopedics
- Pain Management
- Podiatry
- Urology
PRACTICE INCENTIVES
Practice Recognition
The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local and meet our quality targets.
Click photos to enlarge
This month’s gift card winners are:
Julie Borge, North Shore G.I. was recognized for excellent patient outreach efforts to schedule necessary appointments.
Emily Eastman, Lahey Health Primary Care Gloucester was recognized for her positive patient comment on a recent patient experience survey:
“This patient appreciates Emily’s efficiency and professionalism and more importantly she recognizes me when I come in for an office visit or call on the phone. She has a personal connection with her patients”.
Deanna Landry, Coastal Orthopedics Associates was recognized for providing timely and convenient access for patients to their orthopedic physicians.
We appreciate their efforts in supporting the PHO goal to provide high quality, community health care. We will deliver gift cards to the winners each month, and they will be announced in the newsletter and posted on our website.
Be sure to look for the new winners in next month’s issue!
PATIENT EXPERIENCE COMMENTS
CAPE ANN MEDICAL CENTER
- Thank you CAMC for helping and CARING!!! Kelly Sutherland, NP goes above and beyond in
a very difficult healthcare world and her patients appreciate it!
DANVERS FAMILY DOCTORS PC
- Dr. Subroto Bhattacharya (Dr. B.) and his staff consistently provide excellent care – I have excellent confidence in his care.
LAHEY HEALTH PRIMARY CARE, BEVERLY – 900 Cummings Center – Ste. 111W
- I’ve received the very best of care from the receptionist to the nurse and Dr. Emily Chin!
LAHEY HEALTH PRIMARY CARE, BEVERLY – 30 Tozer Rd.
- Great experience! Dr. Nicholas Avgerinos had a lot of terrific knowledge and advice. Loved it!
- Dr. Susan Deluca is the best provider I have ever had. She is knowledgeable, professional and sincerely caring about her patients I have recommended her to several people.
- Dr. Gail Ellis is the most caring, patient, understanding, compassionate, intelligent physicians and so nice! She’s always been there for me!! THE BEST!
LAHEY HEALTH PRIMARY CARE, DANVERS – 140 Commonwealth Ave. – Ste.201
- Dr. Mauri Cohen and staff have provided me with excellent care, and with a genuine concern for improving my health.
LAHEY HEALTH PRIMARY CARE, DANVERS – 480 Maple St. – Ste. 204
- Dr. Galina Feldman is the best physician I have had in a long time. Compassionate, easy to get a quick appointment when needed.
- Always have a good experience with Dr. Manju Sheth. She is very kind and caring.
LAHEY HEALTH PRIMARY CARE, GLOUCESTER − 298 Washington St. – 4th. floor
- Dr. Karen Damico always takes time listening to me & my concerns. I actually have recommended her
to several people.
LAHEY HEALTH PRIMARY CARE, GLOUCESTER − 298 Washington St. – 1st. floor
- Dr. Amy Esdale is an excellent physician. She and her staff are always professional and very helpful.
LEONARD HOROWITZ, M.D.
- Dr. Leonard Horowitz and his staff are excellent – the best in healthcare.
NORTH SHORE PEDIATRICS
- Dr. David Danis is the upmost professional. He’s an excellent doctor and always addresses all of my children’s needs and concerns. Outstanding in every aspect!
- We love Dr. Shannon Dufresne and have recommended her to others. She is relatable,
kind and knowledgeable.
THOMAS PEARCE, M.D
- Great visit – very good care given. Dr. Thomas Pearce is one of the best!