October 2025

Healthcare professionals play a vital role in helping patients improve their Health Literacy. The CDC defines health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” We should work with our patients to make sure they understand what we are doing as healthcare professionals while also teaching patients how to find information to better understand their own health.

Understanding Our Patient’s Health Literacy Levels

According to the Center for Health Care Strategies “Nearly nine out of 10 adults in the United States struggle with health literacy”. At each patient encounter, we need to look for ways to determine their level of health literacy, either through a formal screening process or an informal conversation. Doing this at each visit is an easy way to get a better understanding of patient’s health literacy levels, and work with them to improve this over time.

Impact of Low Health Literacy

Studies have shown that low health literacy can be linked to an increase in hospitalizations, decreased medication adherence, higher mortality rates, and increased health care costs. It also can lead to poor self-management of patient’s health needs and delayed diagnosis for many conditions.

What We Can Do

By working with patients on their health literacy, we can help improve health outcomes – leading to healthier and happier patients. Take time at each appointment to assess a patient’s level of health literacy and ways to increase it. By doing this, patients will have a better understanding of their health, and what they can do to improve it.

Tips to help assess and improve patient health literacy include:

• Ask open-ended questions, allowing the patient to explain what they understand. The provider can fill in the missing pieces after listening.
• Encourage patients to ask questions.
• Use the “teach back” method after explaining information to patients, to make sure they understand what healthcare providers are telling them.
• Use simple phrases that minimize the risk of the patient not understanding.
• Avoid medical terminology, using more common phrases instead.
• Speak to patients at a 6^th grade reading level (AMA recommendation).
• Provide patients with resources that fit their specific medical needs.
• Screening for and awareness of the Social Determinants of Health.

Incorporating these techniques into every office visit can help patients vastly increase their health literacy and can lead to better outcomes for all our patients.

Additional information and resources

Readability of Patient Education Materials from High-Impact Medical Journals: A 20-Year Analysis, Journal of Patient Experience

8 Ways to Improve Health Literacy, Institute for Healthcare Improvement

Impact of Low Health Literacy on Patients' Health Outcomes: a Multicenter Cohort Study, BMC Health Services Research

Health Literacy, Social Determinants of Health, and Disease Prevention and Control, Journal of Environmental Health Science

Health Literacy Fact Sheets, Center for Health Care Strategies

Primary Care Providers (PCPs) are the front line for detecting and preventing the transmission of HIV. According to the CDC’s recommendations, and those of the US Preventive Services Task Force (USPSTF), PCPs should conduct routine HIV screening at least once for all patients older than 13 years of age, and more frequent testing should be offered to those with ongoing risk (i.e. new sexual partners). In the event of a positive test result, early detection and referral to a provider with experience treating HIV is vital to optimizing individual patient outcomes, and also in reducing transmission within the community.

Evidence suggests many patients who are at high risk and who are being seen by their PCPs are NOT being offered HIV testing (and in many cases are not having a comprehensive sexual history conducted). HIV testing should be offered as part of routine bloodwork, which includes cholesterol and diabetes screening and basic metabolic panels.

For front line providers, it is essential to at least offer HIV testing and/or initiate conversations about Pre-Exposure Prophylaxis (PrEP) to patients at greatest risk of HIV transmission during routine office visits. In fact, the USPSTF recommends HIV testing (and counseling about pre-exposure prophylaxis) as grade A recommendations. These are stronger recommendations than even their recommendations for biannual mammography in women over 40 years of age. 

Evidence suggests that while PrEP can be costly, in populations with both a high risk and a high prevalence for infection, e.g. adolescent men who have sex with men, and transgender women of color, use of this biomedical intervention can be cost effective. In fact, for people insured by NY State, all forms of PrEP are covered by their insurance.  Most people do not take these prescriptions for long periods of time as they can discontinue it when their life circumstances change.

In keeping with Independent Health’s priority to “End the Epidemic” and optimize health outcomes for all of our members, regardless of race, ethnicity, age, gender, or sexual orientation, Independent Health has created a “PrEP Provider Toolkit” to serve as a vital resource to prevent your patients from becoming infected with HIV. The toolkit is in the secure provider portal. From the Resources tab, click "HIV Prevention."

HIV does not discriminate; any patient can be living with the virus or be infected with it. Unfortunately, several marginalized patients, including people of color, transgender people, and men who have sex with men, are disproportionately affected by this blood borne infection.

There are more than 100,000 people living with HIV in New York State, including more than 3,000 people in Erie County alone. A startling truth is that approximately one in seven patients living with HIV does not know their HIV status. These patients are more likely to continue unsafe sexual or needle sharing practices, thus infecting their partners.

The stigma surrounding HIV is the primary reason that so many people do not know their status. But prescribers and their clinical staff can help to reduce this barrier to optimal health outcomes. The toolkit provides many valuable resources for prescribers who feel unprepared or who feel that they do not have the time to tackle this important health topic.

What can you do?

Work with all your patients to “Expect the Test.” New York State, in accordance with recommendations from the Centers for Disease Control and Prevention (CDC) and US Preventive Services Task Force (USPSTF) require HIV testing be added to all routine bloodwork as the standard of care for all people aged 13 and older. Additional tests should be offered for those with ongoing risk (i.e., each time they have a new sexual partner).  For details, read the November, 2024 letter from the NYSDOH here about HIV testing.

De-stigmatize all aspects of human sexuality. The toolkit provides resources on how to conduct routine sexual history and risk assessments for all your patients, regardless of age, race, gender, or sexual orientation. We understand that this may feel uncomfortable at first. The toolkit provides resources on how to normalize these conversations across populations, and helps clarify why asking these questions is important. Make your office a “safe space” for all sexual or gender minorities. The toolkit offers examples of nonjudgmental questions to ask, and works to make these histories complete and concise.

Learn More about Pre-Exposure Prophylaxis (PrEP). The toolkit walks prescribers who are unfamiliar with PrEP step by step through the entire process, from taking a sexual history to what to do if a patient tests positive for HIV. It offers advise on how to determine which patients might benefit from PrEP, as well as how to discuss prevention alternatives with your patients. It reviews the known data regarding risks versus benefits of PrEP prescriptions, and reviews how to approach stopping these therapies when appropriate. The toolkit also clearly details the questions that should be asked, what should be monitored, and the labs that should be drawn at every three-month visit.

Remember to utilize community resources. Patients who utilize PrEP do not need to be seen in the office every three months. Labs can be drawn at external sites, and upon review, any prescriptions can be electronically prescribed. Utilize your staff, including clinical pharmacists or nurses, to follow up with patients regarding adherence or adverse event management. The toolkit also provides information about other clinics in the area that are prescribing PrEP, and these prescribers can serve as “PrEP mentors”, or as referral sites.

When in doubt, ask! Independent Health works closely with the New York State AIDS Institute and local Ending the Epidemic committees, and our team can work with you to create streamlined protocols surrounding sexual history taking, risk assessment, or PrEP prescription. We can also address any clinical or psychosocial questions or concerns you have regarding the information in the toolkit. Our clinical pharmacy and case management teams are here to help!

Independent Health is required by state and federal agencies to ensure our participating providers complete this annual compliance training. 

What are providers required to do?

All participating practices must attest they have completed each of the following by December 31, 2025.

A.      Cultural Competency Training:

All providers who treat Independent Health’s Commercial and State program members must attest annually that they have completed cultural competency training for all staff who have regular and substantial contact with our members. Staff must complete one of the following:

• The U.S. Department of Health & Human Services online module, “The Guide to Providing Effective Communication and Language Assistance Services,” or,
•  The comparable Think Cultural Health training that corresponds with the provider’s scope of practice, and submit the electronic attestation to confirm completion.

B.      Fraud, Waste & Abuse Training:

Independent Health requires each of its participating provider groups or practices to complete Fraud, Waste & Abuse (FWA) Training and submit an electronic attestation to confirm each of their staff members have completed this training. 

Staff members required to complete this training include physicians, mid-levels, ancillary providers, registered nurses, licensed practical nurses, administrative and office staff, technicians, coders and others.

Who must submit each attestation? 

An authorized representative must submit each of the above attestations on behalf of all individuals under a practice’s Tax Identification Number (TIN). Therefore, each individual staff member who completes each training does not need to submit the attestation.

How do I start these attestations?

The materials are posted on our website.  To begin: Start the Attestations here

I have already completed training for another entity. Do I need to take it for Independent Health?

If your practice has already completed 2025 Cultural Competency through another source and has a roster or spreadsheet with the dates the training was completed, you may submit the attestation through each of Independent Health’s public provider portal pages. 

If  your practice has already completed the 2025 FWA training and attestation through Independent Health, it is not necessary to attest to doing so again. 

We have informed relevant providers directly by secure message about upcoming prior authorization requirements and policy changes that will go into effect in the upcoming months. For reference, these changes are summarized below:

• Prior authorization for select interventional cardiology and vascular services: As of October 15, services will require prior authorization through Evolent prior to being rendered in an outpatient or inpatient* (*professional component of elective services only) setting for adult commercial and Medicare lines of business, such as: Cardiac catheterization and intervention, Electrophysiology, Vascular radiology and intervention, Cardiac surgery, Vascular surgery. For additional information visit Evolent’s resources page about this.
• Prior authorization for physical medicine services: Beginning with services on and after October 15, physical therapy, occupational therapy, and speech therapy services will require prior authorization through Evolent prior to being rendered in provider offices, outpatient hospitals, and comprehensive rehabilitation facilities for our Medicare line of business. For additional information visit Evolent’s resources page about this.
• Prior authorization for radiation oncology: Effective November 1, for services on or after that date, Evolent will provide management services for the following radiation oncology therapy treatments on our commercial and Medicare lines of business for members aged 18 and older for primary and metastatic cancers being treated with:  Low-dose-rate (LDR) Brachytherapy, High-dose-rate (HDR) Brachytherapy, Image Guided Radiation Therapy (IGRT), Intensity Modulated Radiation Therapy (IMRT), Proton Beam Radiation Therapy (PBT), Three-dimensional Conformal Radiation Therapy (3D-CRT), Two-dimensional Conventional Radiation Therapy (2D), Stereotactic Radiosurgery (SRS), Stereotactic Body Radiation Therapy (SBRT). This prior authorization program does not include our State Programs or Self-funded products. More information is available here.  

Flu Shot Campaign

This campaign will encourage adult members to receive a flu vaccine this season.  Practices are also encouraged to further reinforce the importance of the flu vaccine with their patients.

• Target Population: Adult members in Commercial, Medicaid, and Medicare LOBs
• Outreach method: Email and digital correspondence
• Timeframe: September 2025 to January 2026

Metabolic Monitoring for Children and Adolescents on Antipsychotics

The Independent Health Behavioral Health and Pediatric Case Management departments will outreach to parents or guardians of members under the age of 13 who have been prescribed an antipsychotic medication but have not received metabolic monitoring (glucose and cholesterol testing).   The Case Manager will provide the parent/guardian with education on the importance of metabolic screening for the child and encourage follow-up conversation with the provider regarding testing.

• Outreach method: Outbound telephone call campaign
• Target members: Commercial and Medicaid managed care members under the age of 13 who are prescribed antipsychotics and have not received metabolic monitoring (glucose and cholesterol testing).
• Timeframe: September & October 2025

State Member Incentive Program Campaigns

Independent Health State members will have until December 31, 2025, to complete various preventive care visits and screenings to receive an incentive for the following programs:

• Gaps-in-Care Program - State members can earn gift cards for completing various preventive care tests and screenings included in the program.
• Non-Utilizer Program - State members with 7 or more months of continuous enrollment without a claim on file are eligible to earn a gift card for completing an annual well visit.
• Maternity Management Program - State members can earn gift cards for completing a prenatal visit during the first 12 weeks of pregnancy and postpartum visit within 11 weeks after delivery.
• Timeframe: July through December 31, 2025

Health-Related Social Needs Self Screening

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

• Target Population: Essential Plan members
• Outreach Method: Email and telephone
• Timeframe: July to December 2025

We have updated the Provider Inquiry Form that will help direct the inquiry to the proper team at Independent Health that can handle your request. 

Please download the form which is available in:

• The Secure Provider Portal: Click the Office Management tab in the red banner, then Office Forms > Administrative Forms.
• Public Provider pages: Under Frequently Used Forms > Provider Forms.

For your convenience, the form is available here, too.  

This form must accompany all claim denial disputes.  In addition, you must include the Provider Inquiry Form when you submit medical records for claims payment disputes. 

October marks National Pharmacy Month, a time to recognize the vital contributions pharmacists, pharmacy technicians, pharmacy assistants, and pharmacy students / interns make to the healthcare system.

Despite their extensive training, accessibility, and proven impact on patient outcomes, pharmacists remain underutilized in healthcare teams. Several key factors contribute to this concern:

• Historical perception and role limitations – as a result of public perception, and aided by a lack of support from other health care providers, pharmacists are still viewed as dispensers of medication. This is despite the fact that most pharmacists have six to ten years of formal education in pharmacy practice.
• Lack of integration into care teams – pharmacists are often siloed from other health care providers, and with lack of formal structures for collaboration (shared electronic medical records, interdisciplinary team meetings) their insights into medication management are not consistently utilized.
• Regulatory and legislative barriers – in NYS, restrictive scope-of-practice laws limit pharmacist ability to fully leverage their training to intervene in medication related issues.
• Workforce and workplace constraints – in retail settings, pharmacists are often overburdened with dispensing duties, leaving little time for patient  counseling or clinical interventions.
• Reimbursement challenges – since they are not universally recognized as providers, there are challenges in their ability to be reimbursed for clinical services. This financial barrier discourages healthcare systems from integrating pharmacists into healthcare teams, even when their involvement could help reduce overall healthcare costs.

The Pharmacist’s Role in Patient Care

Despite these challenges, there is a growing recognition of pharmacists’ value in improving health outcomes. Pharmacists are medication experts who provide critical support in:

• Medication Therapy Management (MTM) services
• Medication reconciliation and adherence
• Identifying and resolving drug therapy problems
• Monitoring for adverse drug reactions and interactions
• Educating patients on proper medication use
• Supporting chronic disease management

These services are not just ancillary, they are essential. Studies consistently show that pharmacist-led interventions improve clinical outcomes in conditions like diabetes, asthma, human immunodeficiency virus, hypertension, and heart failure.

The Pharmacist’s Role in Public Health

Pharmacists are increasingly recognized as essential contributors to public health, far beyond their traditional roles in medication dispensing. Their expertise in pharmacotherapy, accessibility within communities, and patient-centered approach position them as key players in promoting health and preventing disease. During public health emergencies, pharmacists also manage medication supplies, disseminate critical health information, and support vaccination campaigns.

Reducing Health Care Costs Through Collaboration

Collaborative care models that include pharmacists have demonstrated significant cost savings, particularly through better resource utilization. By preventing medication-related hospitalizations, reducing polypharmacy, and improving adherence, pharmacists help lower the financial burden on both patients and the healthcare system. Pharmacist led interventions also reduce avoidable readmissions further improving healthcare costs and patient health outcomes.

For example, MTM services have been shown to:

• Decrease emergency department visits and hospital readmissions
• Improve medication adherence rates and reduce medication related adverse events
• Enhance patient satisfaction and engagement in their health outcomes

In value-based care models, pharmacists are instrumental in driving measurable improvements in clinical outcomes. Their involvement ensures that medication-related decisions are evidence-based, patient-centered, and aligned with broader treatment goals.

A Call to Strengthen Interprofessional Collaboration

As we celebrate National Pharmacy Month, we invite physicians and other healthcare professionals to deepen their collaboration with pharmacists. Whether through shared electronic health records, interdisciplinary team meetings, or direct referrals for MTM services, stronger partnerships lead to better care.

Independent Health’s Pharmacy Department includes a team of Medication Therapy Management (MTM) pharmacists. We are uniquely positioned to optimize medication use, improve patient outcomes, and reduce overall healthcare costs—especially when working in close collaboration with physicians, nurses, and other healthcare providers.

Together, we can:

• Ensure safer, more effective medication use
• Empower patients to take control of their health
• Build a more sustainable healthcare system

Pharmacists are integral members of the healthcare team. This October, let’s recognize their contributions and commit to working together to deliver the highest quality care to our patients.

Providers will need to be logged in to the Prime Therapeutics portal to view all drug policies associated with the program. Previously, drug policies were available without having to log in.

• If you already have a portal account with Prime Therapeutics, no action is required. Your existing credentials provide access to the drug policies when you log in.
• If you do not have a portal account with Prime Therapeutics, click on “new provider access request” on the portal landing page.

Prime Therapeutics, formerly Magellan, reviews prior authorizations for select oncology and specialty drugs that fall under either the medical or pharmacy benefit.

Drug Formulary Changes

View the formulary deletions, effective October 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

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

Prime Therapeutics reviews prior authorizations for select oncology and specialty drugs on Independent Health's behalf. Log in to 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.

Independent Health once again New York State's Highest Rated Commercial Health Plan - Sept. 15, 2025

For the third consecutive year, Independent Health has earned the highest possible overall rating of 5 out of 5 stars, according to the National Committee for Quality Assurance’s (NCQA) 2025 Commercial Health Plan Ratings.