September 2023

Overuse and misuse of antibiotics encourage the development of antibiotic-resistant bacteria. This article includes easy ways to help maintain the efficacy of antibiotics.

The Centers for Disease Control and Prevention (CDC) estimates that in the United States antibiotic-resistant bacteria cause over 2.8 million illnesses and more than 35,000 deaths each year. Additionally, antibiotic resistance has a national cost of $4.6 billion annually.

The primary drivers of antibiotic resistance are overuse and misuse. The CDC estimates 28% of antibiotics prescriptions written were unnecessary. Of the necessary antibiotic prescriptions written, 50% included inappropriate antibiotic selection, dosage, and duration of use.   

To help curb the rate of antibiotic resistance, follow these educational and counseling tips: 

• Prevent infections: Everyone has a role to play in preventing infections.     
  • Keep your hands clean. Counsel patients on proper hand washing technique and explain how this fights germs. 
  • Get vaccinated. Encourage age- and risk-appropriate vaccinations for flu, COVID, RSV, and pneumonia. 
• Watchful waiting. Two out of three children with otitis media will recover without antibiotics. 
  •   The American Academy of Family Physicians (AAFP) recommends not using antibiotics in children ages 2 to 12 years with non-severe symptoms unless symptoms persist for more than 48 to 72 hours. 
• Viral infections: antibiotics are not indicated for viral infections.
  • Acute bronchitis is caused by a virus in approximately 95% of cases.
  • Upper respiratory tract infections are most commonly caused by viruses.
  • Pharyngitis is caused by a virus in approximately 50% to 80% of cases.
  • The common cold and flu, both caused by viruses, are easily confused. Help patients differentiate between them. 
  • If a patient has the flu, an anti-viral is most effective if used within 48 hours of illness onset. These include oseltamivir (Tamiflu), zanamivir (Relenza) or baloxavir marboxil (Xofluza).  Prevention is the best approach. Encourage patients to receive their annual flu shot. 
• Steptococcal pharyngitis: symptoms overlap with other diseases.
  • According to the AAFP guidelines, a diagnosis of steptococcal pharyngitis requires a positive test for group A Streptococcus prior to treatment. 
  • Empiric treatment with an antibiotic may be used with a Centor Score* of 3 or higher or with a positive rapid test result.
• Improper use. If an antibiotic is required, inadequate doses or ending treatment early may lead to resistance. 
  • Counsel patients to take the full dose of their antibiotic for the duration prescribed. 

To help start a conversation with your patients, consider displaying commitments in support of antibiotic stewardship in your office. Poster-size commitment letters in examination rooms can help reduce inappropriate antibiotic prescribing, which can positively affect some HEDIS quality measures. You can download posters and view other resources on the CDC's Appropriate Antibiotics Use website, the NYS Department of Health's Antibiotic Resistance website and the Choosing Wisely website. 

*Centor Score: A tool to help determine which patients need no testing, a throat culture or rapid antigen test, or empiric antibiotic treatment. The score is based on a patient’s symptoms (cough, swollen/tender cervical nodes, temperature, swollen tonsils/exudate) and age. Additional factors (e.g., a recent contact with a known group A streptococcal infection) may also be considered when determining the need for antibiotic treatment. Choby BA. Diagnosis and Treatment of Streptococcal Pharyngitis. Am Fam Phys. 2009;79(5):383-390

References: 

Centers for Disease Control and Prevention, Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.

Nelson RE et al, National Estimates of Healthcare Costs Associated With Multidrug-Resistant Bacterial Infections Among Hospitalized Patients in the United States, Clin Inf Dis. 2021;72(S1):S17-S26.

Hersh AL et al. Unnecessary Antibiotic Prescribing in US Ambulatory Care Settings, 2010-2015. Clin Inf Dis. 2021;72(1):133-137.

Centers for Disease Control and Prevention (CDC). Office-related antibiotic prescribing for persons aged ≤14 years — United States, 1993—1994 to 2007—2008. MMWR Morb Mortal Wkly Rep. 2011;60(34):1153-6.

Pichichero ME. Dynamics of Antibiotic Prescribing for Children. JAMA. June 19, 2002;287(23):3133-5.

Shapiro DJ et al. Antibiotic Prescribing for Adults in Ambulatory Care in the USA, 2007–09. J Antimicrob Chemother. 2014;69(1):234-40.

Singh A et al. Acute Bronchitis. National Heart, Lung and Blood Institute. Reviewed July 2023.

Thomas M et al. National Library of Medicine. StatPearls. Upper respiratory tract infection. 2021.

Wolford RW et al. Pharyngitis. National Heart, Lung and Blood Institute. Updated May 2023. 

Recently Independent Health announced that we will offer an expanded, comprehensive national network for our commercial and self-funded lines of business this fall.

The enhanced national network will cover members who live outside of Independent Health’s traditional Western New York service area, while serving as the travel network for members who live locally.

To accommodate the national network, all Independent Health commercial and self-funded members will receive new ID cards with new ID numbers upon their plans’ renewal dates. The new ID numbers will begin with “W.” (The ID numbers for Medicare and State program members will not change).

It is important to ask patients if they have new ID cards and to use their new Member ID numbers. However, this should have no effect on your billing, as the new ID number will track to the member’s current ID number.

Timing:

• A limited number of self-funded members will get their ID cards before December 1.
• Starting in December, commercial group members with a January 1 renewal date will begin receiving their new ID cards in December.  Members may begin using their new ID cards as soon as they receive them.

During the month of September, Independent Health will be conducting the following member engagement/outreach campaigns:

Colorectal Cancer Screening Reminder

This telephonic outreach campaign will engage members who are overdue for a colorectal cancer screening.  The purpose of the call is to provide education around the importance of colon cancer screening, address member barriers to screening, and encourage the member to follow through on screening orders received from their provider.  Members that do not have an order for a colon cancer screening test will be encouraged to have a conversation with their provider regarding screening.

• Outreach method: Outbound telephone call campaign
• Target members: Medicare and Medicaid members who are overdue for a colorectal cancer screening
• Timeframe: September 2023

Social Determinants of Health Screening

This telephonic outreach campaign will engage Essential Plan members in a conversation around screening for social determinants of health to identify any needs the member has for things such as food, housing, and transportation.   If a need is identified, Independent Health will assist the member in making a connection to a community resource to address the need. 

• Outreach method: Outbound telephone call campaign
• Target members: Essential Plan members
• Timeframe: September 2023

Breast Cancer Screening Reminder Campaign

This campaign will target women ages 50 to 74 within the Medicaid line of business who are overdue for a mammogram. The goal of this telephonic outreach campaign is to maximize mammography participation. Education around the benefits of receiving a mammogram, as well as information regarding how to address any barriers, and how to follow through with their provider’s orders will be discussed. Members that do not have an order for a mammogram will be encouraged to have a conversation with their provider.

• Outreach method: Outbound telephone call campaign
• Target members: Women ages 50 to 74 who are overdue for a mammogram- Medicaid members only
• Timeframe: September 2023

Educating patients with asthma

Asthma is the most common condition among our commercial and Medicaid populations from children to young adults. In Western New York, over 1.2 million adults were estimated to have asthma in 2021; from 2018-2020, children aged 0-17 years accounted for over 5,000 emergency room visits related to asthma.  Nationally, asthma causes almost 10 deaths per day, with Black Americans being 2 to 3 times more at risk than any other racial or ethnic group.

Starting in September, Independent Health will send eblasts to members regarding asthma and asthma management. The three eblasts include:

1. Asthma Action Plans
2. Coordinating Your Child’s Care between the school nurse and children’s providers to better manage triggers, symptoms, and rescue therapy during school hours.
3. Trigger Identification and Management 

These eblasts have three objectives:

1. Patient self-advocacy and self-management strategies for their asthma, including trigger identification and management
2. Helping patients understand the roles of controller and rescue medications and when to use them to improve asthma outcomes
3. Optimizing the care relationship between school nurses and primary care providers for school age children

Target members: Members age 18 to 64 with a diagnosis of asthma; E-mail #2 is targeted to the guardians of members aged 5 to 18 with a diagnosis of asthma.

Timeframe: one informational eblast from this series will go out each month from August through October.

• Medicare Advantage formulary changes for individual and group members effective Sept. 1, 2023.
  
• Pharmacy Benefit Dimensions 5-Tier formulary changes effective Sept. 1, 2023.
• Pharmacy Benefit Dimensions 3-Tier formulary changes effective Sept. 1, 2023.

View the most up to date versions of Independent Health’s policies when logged in to our provider portal

Magellan Rx, administered by Magellan Rx Management, reviews select specialty drug prior authorization requests on Independent Health’s behalf. To view Magellan Rx policies for the drugs that they review, click here.

Independent Health's drug formulary
Access Independent Health's drug formulary here.

To obtain a hard copy, please contact Independent Health Provider Relations by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.