SCOPE | Provider Update
Helping your patients' hearts
With February as Heart Month, it's a good reminder on the ways to help keep individuals mindful of the importance of heart health.
According to statistics from the Centers for Disease Control and Prevention (CDC):
- Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.
- One person dies every 33 seconds in the United States from cardiovascular disease.
- About 695,000 people in the United States died from heart disease in 2021—that’s 1 in every 5 deaths.
- High blood pressure, high blood cholesterol, and smoking are key risk factors for heart disease.
Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:
Treating at-risk patients and those with cardiovascular conditions
Identify patients with hypertension and other cardiovascular disease CVD risk factors. Manage symptoms, blood pressure and lab results, as indicated, according to evidenced based guidelines.
To learn more about Cardiovascular Management, as well as obtain education, tools, and resources for:
- Lifestyle Changes
- Health Equity
- Blood Pressure monitoring
- Medication Adherence
- Standardized care
- Identifying patients with Hypertension
Visit Resources for Health Care Professionals | cdc.gov for additional information and other resources for American Heart Month
Physicians and their patients with prediabetes are seeing healthy results due to the Brook+ Diabetes Prevention Program
Primary care practices can partner with this digital Diabetes Prevention Program, which has demonstrable results among Independent Health members.
Key measures continue to show that the Brook+ Diabetes Prevention Program is helping Independent Health members increase their physical exercise and lose weight:
- In 2023, almost 1,300 members completed the entire program.
- More than 9 out of 10 participating individuals have lost weight.
- The average weight loss of members who have completed the program is 10%.
Brook+ is a digital Diabetes Prevention Program (DPP) patients can use anytime, anywhere. It's recognized by the Centers for Disease Control and Prevention (CDC) to help participants lose weight (see infographic) and avoid chronic conditions. According to the CDC, participating in a DPP like Brook+ can reduce the risk of type 2 diabetes by up to 58% (71% for adults over 60 years old).
Primary care physicians have also found Brook+ to be extremely motivating to their patients who have prediabetes. Philip Penepent, M.D. has seen how Brook+ supports his efforts in making sure his patients are on track in addressing prediabetes.
"Our pre-diabetes patients are motivated by the one-on-one relationships with their Brook+ Health Coaches,” said Dr. Penepent. “Patients have told me that these coaches are realistic and understanding, which make patients want to succeed. Patients appreciate that Brook+ can be completed on their schedule; without driving to appointments in bad weather and no copays. Brook+ empowers patients to take control of their health and we are very happy to partner with this resource."
Brook+ is available to Independent Health members who meet CDC eligibility requirements. With tools and support to help members achieve real and sustainable health goals, we are pleased to offer the Brook+ healthy lifestyle program to eligible members at no additional cost.
If you are interested in working with Brook to encourage you Independent Health patients to participate, please email Kristin Crosby at firstname.lastname@example.org.
NYS reminds providers about the "Loss of Records due to Unforeseen Event" Medicaid policy
The November 2023 edition of the New York State Medicaid Update includes a reminder about the Medicaid Policy - Loss of Records due to Unforeseen Event.
The November 2023 edition of the New York State Medicaid Update includes a reminder about the Medicaid Policy Loss of Records due to Unforeseen Event. Please note the following from that update:
“Providers whose records have been damaged, lost, or destroyed are required to report that information as soon as practicable, but no later than thirty calendar days after discovery, to the New York State (NYS) Office of the Medicaid Inspector General (OMIG) Self-Disclosure Unit. Failure to report such incidents may result in a determination of overpayment, penalties, and/or sanctions.
Please note: Loss/destruction/corruption/inaccessibility of electronic records must also be included in this reporting requirement to ensure compliance with regulatory standards.”
To self-report, providers must complete the Statement of Damaged, Lost or Destroyed Records form, located on the NYS OMIG "Self-Disclosure Submission Information and Instructions" web page. The NYS OMIG "Self-Disclosure Submission Information and Instructions" web page, additionally offers the NYS OMIG Hightail Secure Uplink website, for form submission, and all required supporting documentation.
Providers must also notify any other State or local regulatory agency of their loss of records due to unforeseen circumstances as required by those agencies.
If an audit or investigation is performed by NYS OMIG and supporting records are missing, NYS OMIG will review the Statement of Damaged, Lost or Destroyed Records form.
If there are any further questions, please refer to the NYS November 2023 Medicaid Update at: New York State Medicaid Update - November 2023 Volume 39 - Number 16 (ny.gov)
Clinical Practice Guidelines updates announced
Independent Health’s Quality Performance Committee has completed its annual review of policies and guidelines.
Independent Health’s Quality Performance Committee has reviewed and approved our Clinical Practice Guidelines which have been updated, where necessary.
Changes include adoption of the following guidelines:
- HIV Guidelines; utilizing NYS DOH AIDS Institute guidelines.
- Asthma - Adult and Pediatric; utilizing NYS DOH guidelines.
- Anxiety – adopted from the American Academy of Family Physicians guidelines.
- Prenatal Care Guidelines
To view the updated clinical practice guidelines, please log into your secure account.
Coming soon: Coordination of care survey
Independent Health wants to make sure we are meeting your needs and ask for your help by completing this important survey.
As part of Independent Health’s ongoing effort to support patient needs, we are seeking feedback regarding the exchange of information and coordination of care between behavioral health clinicians and primary care providers so we may help better facilitate patient care.
In the next few weeks, primary care providers and behavioral health clinicians will receive a survey. By completing it, you will help us to comply with accreditation standards set by the National Committee for Quality Assurance (NCQA).
The NCQA accreditation period spans over three years, with 2024 being our last reporting period in the current three-year cycle. Independent Health uses the feedback received from these surveys to develop our strategies to improve the integration of care and information-sharing across the physical and behavioral health continuums to ensure our tactics align with the needs of our provider partners and members.
Over the last three years we have used your feedback to build interventions to benefit our members. This last survey is for us to monitor the results only; however, if significant concerns are identified in in the survey results additional actions may be taken to address information will be used if there are any significant trends identified in the survey results.
We will be sending the survey to you by March 4, 2024, so we ask that you please be on the lookout for it. It is encouraged to have each provider at your practice complete a survey, so please make sure to share the link with them.
As always, we appreciate your assistance in improving the quality care patients receive.
Annual reminder of Independent Health's Member Rights & Responsibilities
As part of our required annual communications, we are posting our members' rights and responsibilities for providers' reference.
Independent Health annually shares our members’ rights and responsibilities to participating providers who treat our members.
Our members have:
- The right to receive information about the organization, its services, its practitioners and providers, and member rights and responsibilities.
- The right to be treated with respect and recognition of their dignity and their right to privacy.
- The right to participate with practitioners in making decisions about their health care.
- The right to a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- The right to voice complaints or appeals about the organization or the care it provides.
- The right to make recommendations regarding the organization’s member rights and responsibilities policy.
- The responsibility to supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
- The responsibility to follow plans and instructions for care that they have agreed to with their practitioners.
- The responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
The Independent Health Member Rights & Responsibilities policy is posted in the secure provider portal under “Policies & Guidelines” and “Appeals & Grievances”.
If you have questions, please call Independent Health Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.
Upcoming member campaigns to encourage our members to take greater control of their health
On occasion, Independent Health sends educational and informational correspondence to our members to remind them to get the care and services they need. This article provides details on upcoming mailings.
Throughout the year, the Health Care Services and Population Health Management departments deploy various tactics to encourage members to take a more active role in their health.
During the month of February, Independent Health will be conducting the following member engagement/outreach campaigns:
State Non-Utilizer Campaign
Independent Health will partner with Stall Senior Medical to conduct in-home annual well visits for State members who are considered non-utilizers. Non-Utilizers are defined as a member who has not had a claim within 7 or more months from their date of enrollment. The option for members to complete a telephonic visit will also be available.
- Outreach method: In-home or telephonic visits
- Target members: State members who have not had a claim within 7 or more months from their date of enrollment
- Timeframe: Quarterly outreach beginning in February 2024
Formulary and Policy Changes
Stay up-to-date on Independent Health's pharmacy policies and formulary updates.
- Medicare Advantage formulary deletions for individual and group plan members, effective Feb. 1, 2024.
- Pharmacy Benefit Dimensions 3-Tier formulary deletions, effective Feb. 1, 2024.
- Pharmacy Benefit Dimensions 5-Tier formulary deletions, effective Feb. 1, 2024.
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.
In the News
Independent Health President & CEO, Michael W. Cropp, M.D., announces plans for leadership succession - News Release, Jan. 18, 2024
As part of the leadership succession planning process, President and CEO, Michael W. Cropp, M.D., will remain CEO of Independent Health, and he will be supported by current Chief Financial Officer Jim Dunlop who will be elevated to the role of President effective February 26.
Celebrating 5 years of health, wellness & community in Buffalo's Broadway-Fillmore neighborhood - News release, Jan. 29, 2024
Independent Health and Jericho Road Community Health Center are proud to announce the renaming of its state-of-the art fitness facility, The Independent Health Gym and Wellness Center at Jericho Road, reaffirming its commitment to promoting health and well-being in East Buffalo. The rededication event marked a milestone in promoting well-being and accessibility to fitness resources for patients of Jericho Road and the entire Buffalo community.