June 2013 Newsletter
Volume 5 Number 1
We are extremely happy to announce that the Anthem contract has been approved by the Board and was signed on Tuesday, May 28th. The contract is a quality based contract and includes a Care Coordination component. St. Vincent’s Health Partners is the first PHO in the state to have a quality based contract with Anthem.
Important Anthem Online Provider Service (AOPS) Update
AOPS Changes Effective June 14, 2013 – Act Now for Continued Access to Member Eligibility, Benefits and Claim Status
Effective June 14, 2013, online member eligibility (coverage), benefits and claim status will be available only at www.availity.com. SVHP will be scheduling training with Availity specifically for the PHO members over the next few weeks.
Physicians, their office staff and other providers can access information for Anthem members through Availity, one of the largest electronic health information networks that connect providers, health plans and practice management systems with essential real-time business and clinical information. Availity offers a wide variety of online tools that allow providers to access real- time information, including eligibility, benefits, claims and many other services, from multiple payers via one secure sign-on.
For more information, please visit www.availity.com/providers/quick-answers/ .
On Tuesday, May 28th, the Board of Directors also voted unanimously to partner with Accountable Care Associates of Springfield, Ma. Signing of this agreement means that the PHO will enter into a CMS Shared Savings contract. Medicare will continue to offer a Fee-for-Service payment at the point of care. In addition, SVHP will receive a shared savings for the defined patient population. The shared savings distribution will be based upon participation, cost and quality.Meetings will be scheduled over the next few weeks with the practices to educate you on the details of the contracts.
Discussions with SmartHealth-the hospital self-insured product continue as well. We are still on target for an effective date of July 1st.
SVHP is exploring additional quality based contracts with other payors and will keep you apprised of the status.
Clinically Integrated Platform
MedVentive Population Manager Project Status Report: Weekly project conference calls are scheduled each Wednesday with the SVHP and MedVentive teams to discuss progress of the project, areas that are on target and areas that are at risk of not meeting deadlines. Data extraction has begun with the Phase 1 Practice Sites. Data extraction calls with Phase 2 consists of 12 practices sites and began the week of May 28th. The goal is to have all of Phase 2 sites on board by the week of June 3rd. Phase 3 will consist of 8 practice sites.
Care Coordination Sub-Committee Update: The PHO works with physician offices to ensure transitions of care are in place across the continuum. This will assure patients receive the best care in all environments. To accomplish this we are proactively tailoring a patient care coordination process to ensure that each patient is cared for in our network. The process is collaborating between our partner members and St. Vincent’s Medical Center. Our vision is for SVHP to coordinate those processes for each partner to operationalize managed care.
Our initial program development began with an assessment of the system with ongoing meetings, surveys, and data analysis. We have been developing a plan to address gaps in care. We are building the SVHP “Playbook” as a starting point which will be a reference at the point of care for each partner, with the standard of care menu of tools available, and measures. This incorporates the standards of best practice in the various health care settings and satisfies URAC, Anthem, and CMS standards.
We began working with the Care Coordination Subcommittee in May with the transitions of care being represented in our “Play Book”. Currently the IP Heart Failure group, the ED, and the St. Vincent’s Urgent Care Centers are working with the transitions and providing the PHO with feedback as we continue development.
If you have any questions regarding transitions of care please contact Brenda Reig, RN, MSM at email@example.com or (203)-275-0204.
Quality Performance Assessment Sub- Committee: Thank you to all that responded to our letter requesting volunteers to join the committee. The purpose of the sub-committee is to evaluate performance at the provider level and determine remediation. Meetings will be scheduled as directed by the Quality and Utilization Review Committee.
If you have questions regarding the Quality Performance Assessment Sub-Committee, please contact Dr. Michael Hunt, CMO/CMIO at firstname.lastname@example.org or (203) 275-0203.
Please join us for our monthly provider education programs. Each event will include dinner and CMEs will be earned.
Thank you to those that attended our Empowerment Series Program on May 13th-”CMS Shared Savings” by Dr. Philip Gaziano, CEO of Accountable Care Associates. Dr. Gaziano discussed challenges and opportunities related to health care delivery changes and the short term and long term implications of partnering with ACA.
Below is a schedule of upcoming events:
Monday, June 3rd, 6:00-8:00 p.m.
Patient Centered Medical Home St. Vincent’s
Medical Center, Hawley 1
Dr. Thomas Meehan, CMO, Qualidigm will be the
Wednesday, August 7th, 6:00-8:00 p.m.
Patient Engagement St. Vincent’s Medical Center
Thursday, October 3rd, 6:00-8:00 p.m.
Topic to be determined St. Vincent’s Medical
Center, Hawley 2
Please contact Karen O’Driscoll, Director of Professional Relations by email email@example.com or refer to our website www.stvincentsheatlhpartners.org to register for the programs.
Calling All Practice Administrators…
St. Vincent’s Health Partners will begin to have quarterly meetings for the Practice Administrators. We will use this time for education programs, discussions and networking with other Practice Administrators. An email will be sent out in the next week to solicit times and items you would like
to discuss. Please contact Karen O’Driscoll, Director of Professional Relations at firstname.lastname@example.org or at (203) 275-0205, should you have any questions.
Visit our website for information regarding Electronic Prescribing and EHR Incentive Programs through CMS. Each week there are new articles under the “News” tab and a Monthly Featured Article that we feel are important to our members.
Remember to use the Physician Directory Search area when recommending physicians to your patients.
New to the website, under the “Resources” tab is a link to the St. Vincent’s Medical Center Urgent Care Walk-Ins. Please consider referring to the Urgent Care Walk-Ins for non-emergent needs and for holiday and after hour coverage.
Dr. Thomas Raskauskas, CEO/President, (203) 275-0202; email@example.com
Dr. Michael Hunt, Chief Medical Officer/Chief Medical Information Officer, (203) 275-0203; firstname.lastname@example.org
Brenda Reig, RN, MSM, Director of Clinical Quality, (203) 275-0204; email@example.com
Anthony Brockman, Director of Information Technology, (203) 275-0206; firstname.lastname@example.org
Karen O’Driscoll, Director of Professional Relations, (203) 275-0205; email@example.com
Alvino Williams, Jr., IT Analyst/Clinical Integration, (203) 275-0207; firstname.lastname@example.org
Colleen Swedberg, MSN, RN, CNL Care Coordinator, (203) 275-0209; email@example.com