June 2025

As a health care provider, you play a critical role in eliminating preventable maternal morbidity and mortality.

That’s why Independent Health has created an evidence-based online Maternity toolkit to assist you with educational content, tools, and resources.

The risk of pregnancy-related complications continues for one year after a pregnancy ends. It’s crucial for any health care professional to identify patients who are pregnant or who were pregnant in the last year and to be aware of the urgent maternal warning signs from complications.

Always Ask if Your Patient Is Pregnant or Was Pregnant in the Last Year

Pregnancy or postpartum status may not be something your patient or their support thinks about sharing, particularly with their primary care physician, but it could be the difference in making an accurate and timely diagnosis.

According to the Centers for Disease Control and Prevention (CDC), some warning signs that could signal a medical emergency include:

• Severe headache
• Dizziness or fainting
• Changes in vision
• Fever
• Trouble breathing
• Overwhelming tiredness
• Chest pain
• Severe belly pain
• Severe nausea and vomiting
• Severe swelling
• Thoughts about harming self or baby

Immunizations

The Advisory Committee on Immunization Practices (ACIP) clinical guidelines recommend that all women who are pregnant or who might be pregnant in the upcoming influenza season receive inactivated influenza vaccines.

ACIP also recommends that pregnant women receive one dose of Tdap during each pregnancy, preferably during the early part of gestational weeks 27 to 36, regardless of prior history of receiving Tdap.

Important reminders

• Always discuss immunization status.
• Screen patients for depression utilizing an evidenced-based, validated screening tool (ex: PHQ2/9), and refer to a Behavioral Health Specialist, if the patient has a positive screen.
• Ensure linkage with an Obstetrician or Nurse midwife for early prenatal care, if pregnant.
• Perform a medication review and assess for potential contraindications.
• Document pregnancy information and any referrals made.

Need Help?

To assist you in helping patients manage uncontrolled chronic diseases or for care coordination needs, please call Independent Health’s Case Management team (716) 635-7822 from Monday – Friday, 8 a.m. to 5 p.m. One of our Case Managers will assist.

View our Maternity Toolkit is under the Resources menu on the secure provider portal.

Helpful Resources

Warning Signs poster: Urgent Maternal Warning Signs Educational Materials | HEAR HER Campaign | CDC

Dietary Guidelines for Americans, 2020 - 2025: Professional Resources | Dietary Guidelines for Americans

Patient Health Questionnaires: Administering the Patient Health Questionnaires 2 and 9 (PHQ 2 and 9) in Integrated Care Settings

Anticholinergic Agents

Anticholinergics have consistently appeared on the Beers Criteria as potentially inappropriate medications for older adults due to their heightened sensitivity to side effects from these medications. These adverse effects include tachycardia, urinary retention, constipation, dry mouth, blurred vision, exacerbation of narrow-angle glaucoma, cognitive impairment, psychomotor slowing, confusion, sedation, and delirium.

Current guidelines advise avoiding the concurrent use of two or more anticholinergic drugs due to the elevated risk of these side effects, particularly cognitive decline (such as delirium, dementia, and cognitive impairment). The longer these medications are used, the greater the associated risk.

To promote safer prescribing, limit anticholinergic medication use in individuals over 65 and consider deprescribing when feasible. When an anticholinergic drug is necessary, recommend using the lowest effective dose for the shortest duration and regularly reassessing its benefit. Additionally, explore alternative agents with lower anticholinergic activity to minimize or eliminate the anticholinergic burden.

Below is a list of alternatives for reference:

Opioids & Benzodiazepines

Simultaneous use of opioids and benzodiazepines raises the risk of potentially fatal severe respiratory depression or overdose. According to the 2023 Geriatric Beers Criteria, healthcare providers should avoid prescribing opioid pain medications and benzodiazepines together whenever possible, except when patient circumstances necessitate appropriate concurrent use (e.g., severe acute pain in a patient on long-term, stable low-dose benzodiazepine therapy).

For chronic pain management, non-pharmacologic options include acupuncture, chiropractic care, cold and heat therapy, exercise, movement, massages, occupational therapy, physical therapy, rehabilitation therapy, and high-tech treatments using radio waves and electrical signals.

Cognitive behavioral therapy has demonstrated effectiveness in treating depression, anxiety, stress, and chronic pain. As safer alternatives for anxiety treatment, consider escitalopram, venlafaxine, duloxetine, or buspirone.

The CDC recommends tapering opioid medications before tapering benzodiazepines due to the higher risks associated with benzodiazepine withdrawal compared to opioid withdrawal.

To learn more, here is a link to deprescribing resources and guidelines.

As the backbone of the health care system, providers are often under immense pressure, which can lead to physical, emotional, and mental exhaustion. Recognizing and addressing burnout is not only essential for the well-being of health care professionals but also for the quality of care they provide to patients.

Understanding Burnout

Burnout is a state of chronic stress that leads to physical and emotional exhaustion, cynicism, and a feeling of reduced professional efficacy. It is particularly prevalent in high-stress professions like health care, where providers are constantly dealing with life-and-death situations, long hours, and the emotional toll of patient care. Symptoms of burnout can include fatigue, insomnia, depression, anxiety, and a decrease in job performance.

The Impact on Health Care Providers

Health care providers experiencing burnout are at risk of numerous negative outcomes. These can range from mental health issues such as depression and anxiety to physical health problems like cardiovascular disease. Burnout can also lead to substance abuse as providers may turn to alcohol or drugs as a coping mechanism. The personal toll is significant, but it also affects their relationships, the people they care for, and the people they love.

The Consequences for Patient Care

The repercussions of burnout extend beyond the individual provider to the patients they care for. Burnout can lead to decreased empathy, impaired judgment, and increased likelihood of errors, all of which can compromise patient safety and care quality. Burnout is associated with lower patient satisfaction, longer recovery times, and higher rates of medical errors. Therefore, addressing burnout is crucial for maintaining high standards of patient care.

Organizational Responsibility

Health care organizations have a responsibility to recognize and mitigate burnout among their staff. This can be achieved through various strategies, such as promoting a healthy work-life balance, providing mental health support, and creating a supportive work environment where everyone feels appreciated and important. Implementing regular check-ins, offering professional development opportunities, and ensuring manageable workloads are also effective measures. By fostering a culture that prioritizes the well-being of health care providers, organizations can enhance job satisfaction and reduce turnover rates.

The Role of Self-Care

While organizational support is vital, health care providers must also prioritize their own well-being. Practicing self-care, setting boundaries, and seeking professional help when needed are essential steps in preventing and managing burnout. Engaging in regular physical activity, maintaining a healthy diet, and ensuring adequate rest are fundamental aspects of self-care. Additionally, providers should cultivate hobbies and interests outside of work to maintain a balanced and fulfilling life.

Conclusion

Recognizing and addressing burnout in health care providers is imperative for the sustainability of the health care system. By taking proactive steps to support the well-being of providers, both organizations and individuals can ensure that health care professionals remain healthy, motivated, and capable of delivering the highest quality of care to their patients. It is a shared responsibility that ultimately benefits everyone involved in the health care continuum.

Health-Related Social Needs Self Screening

This email campaign will encourage Essential Plan members to complete a self-administered health-related social needs screening as well as provide community resources for members to contact if an area of need is identified.

• Target Population: Essential Plan members
• Outreach Method: Email
• Timeframe: ongoing

Osteoporosis Management in Woman Who Had a Fracture (OMW) Member Outreach
Independent Health’s Case Manager will outreach telephonically to Medicare members that fall into the Osteoporosis Management in Woman Who Had a Fracture (OMW) measure.

Independent Health’s Case Manager will contact members to discuss their fracture, provide education on fractures and falls prevention, and discuss options for gap closure.

The Case Manager will discuss the option of an in-home heel ultrasound with Stall Senior Medical (SSM). If the member is interested, the Case Manager will ask for consent for the member to be contacted by the SSM team and then SSM will call the member to schedule the appointment. All results will be sent to the member’s Primary Care Physician (PCP) for follow-up.

The Case Manager will also discuss other options for gap closure, depending on the member’s preference, and refer back to the member’s PCP. Each call will be individualized based on the member’s needs.

• Target population: The OMW measure focuses on females 67 to 85 years of age who had a fracture and have six months following the fracture to close the gap by having a bone density scan, filling a script for an osteoporosis medication, or receiving an injection for osteoporosis treatment.
• Timeframe: This outreach is on-going. Monthly, new members who fall into this measure are called. 

Eye Exam for Patients with Diabetes (EED) Member Outreach 
Independent Health will be facilitating outreach telephonically to Medicare members that have a gap in care for the Eye Exam for Patients with Diabetes (EED) measure.  Independent Health will call members and discuss the option of an in-home eye exam with Stall Senior Medical (SSM). If the member is interested, Independent Health will ask for consent for the member to be contacted by the SSM team and then SSM will call the member to schedule the appointment. All results will be sent to the members’ Primary Care Physician (PCP) for follow-up.

• Target population: Medicare HMO members with a diagnosis of Diabetes (type 1 or 2) who have not had a retinal eye exam. An eye exam in the year prior must be negative for any type of retinopathy. If year prior eye exam is positive, then an eye exam in the current measurement year is needed.
• Outreach method: Outbound telephone call campaign.
• Timeframe: Campaign kicked off in mid-to-late March and runs through December 2025

Gaps in Care Reminder Calls 
Independent Health’s Member Servicing team will perform telephonic outreach to provide education and encourage members with an open gap in care to reach out to their provider to schedule the appropriate appointments and/or get a vaccination to complete the gaps in care.

• Target populations: Medicaid Managed Care members who have open gaps for: breast cancer, colorectal, and/or cervical cancer screenings.  Medicaid Managed Care and Child Health Plus members (ages 9-12) who have not started or who have started but not completed the series for HPV vaccinations. 
• Timeframe: Call campaign began in May

Falls Prevention Campaign
This campaign targets Medicare members identified as having a high likelihood of falling or history of falls to provide fall prevention education and encourage members to speak to their doctor about ways to prevent falls.

• Target population: Medicare members who have a high likelihood of falling or a history of falls.
• Outreach method: Outbound telephone call and email campaign.
• Launch Date: Telephonic outreach began in late April; Email campaign will occur between May through July.

Physical Activity Campaign
This campaign targets Medicare members identified as having low physical activity levels to provide education regarding the benefits of physical activity and encourages members to speak to their doctor about ways to be more active.

• Target population: Medicare members who have low physical activity levels.
• Outreach method: Outbound telephone call and email campaign.
• Launch Date: Telephonic outreach began in late April; Email campaign will occur between May through July.

Bladder Control Campaign
This campaign targets Medicare members identified as having urinary incontinence and encourages them to speak to their PCP regarding urinary incontinence and potential solutions.

• Target population: Medicare members who self-identify as having urinary incontinence.
• Outreach method: Outbound telephone call and email campaign.
• Launch Date: Telephonic outreach began in late April; Email campaign will occur between May through July.

Physical and Mental Health Campaign
This campaign targets Medicare members identified as having concerns with their physical or mental health to provide education regarding who to contact about any physical and mental health concerns and encourages them to speak to their doctor about these concerns.

• Target population: Medicare members who are identified as having concerns with their physical or mental health.
• Outreach method: Outbound telephone call and email campaign.
• Launch Date: Telephonic outreach began in late April; Email campaign will occur between May through July.

Drug Formulary Changes

View the formulary changes for the Second Quarter of 2025.

View the formulary deletions, effective June 1, 2025:

• Medicare Advantage formulary deletions for individual & group plan members
• Pharmacy Benefit Dimensions 3-Tier formulary deletions
• Pharmacy Benefit Dimensions 5-Tier formulary deletions

Access Independent Health's drug formularies here.

Drug Policy Changes

The policy changes for the Second Quarter of 2025 are now available online. Log in to the provider portal to view the changes. Click on ‘Monthly Policy Updates’ under the News tab once you are logged in.

Search for and view the most current versions of all Independent Health’s drug policies when logged in to our provider portal.

Prime Therapeutics (formerly Magellan Rx) reviews prior authorizations for select oncology and specialty drugs on Independent Health's behalf. View Prime Therapeutics' policies for the drugs it reviews. 

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 5 p.m.