TEL. | Care Management |
| Provider Delivered Care Management (PDCM) Training Requirements As a reminder, for licensed and unlicensed care team members to bill PDCM codes, they must complete the Introduction to Team Based Care Training within 6 months. This is a required training. It is offered through Practice Transformation Institute (PTI) at no cost to Medical Network One practices. Information on upcoming trainings is available in the MedNetOne Connect Newsletter, and can also be found under the “Events” tab on PTI’s website https://www.transformcoach.org/ The next virtual training will be held on April 20 and April 21, 2022 from 8:30am to 12:30pm. Please use the link below to register. If you have any questions, please contact Yang Yang at [email protected]. Medical Network One practice’s registration link: https://transformcoach.wufoo.com/forms/introduction-to-teambased-care-42042122/ Patient Engagement Training, also offered through PTI is not required but is strongly encouraged for those providing care management services. Be sure to look at upcoming dates for this training as well. Both mentioned trainings provide longitudinal learning hours to meet the yearly training hours required by Blue Cross Blue Shield of MI (BCBSM). Erica Ross, Clinical Services Manager |
| Patient Centered Medical Home |
| Welcome to the Blue Cross Blue Shield of Michigan Patient Centered Medical Home (BCBSM PCMH) monthly newsletter update! Each month we will bring together all relevant PCMH news and updates for our participating provider community. This month we will discuss the requirements for new capability 9.14. 9.14 Systematic approach in place to screen all patients to identify those with bladder control issues PCP and Specialist Guidelines: A. Practice must have a scripted discussion yearly regarding bladder control and if bladder control is a problem. Also, discuss when it has been a problem and other symptoms that may be accompanying this problem (for adult patients only) I. Discuss treatments for bladder control issues that may arise as patient ages, such as behavioral therapy, exercises, medications, medical devices, or surgery II. Provide educational brochures and materials such as conversation starters B. Approach for improving bladder control should include education related to bladder incontinence I. Discuss how leaking of urine impact daily activities or interferes with sleep II. Discuss urgency and frequency of elimination PCMH Validation Notes of Site Visits: · Show documented discussion about improving bladder control ·Show examples of materials ·What options are offered to assist adult patients in improving bladder control? Kathryn Correll-Rice, Manager of Quality Improvement Strategy |
| Corporate Affairs |
| Since the pa, we have all pandemic began, we have all been impacted from the use of Telehealth, whether it be in our practices or with our own family members utilizing the service. Televisits are here to stay, and the enhancements of the Telehealth experience has grown: Adopt self-scheduling and electronic check-in Using healow® Open Access®, you can reduce incoming phone calls by allowing patients to self-schedule appointments. Open Access means less work for your front-office staff and can both reduce no-shows and improve patient satisfaction. Next, patients use healow CHECK-IN™ to complete the pre-visit process — confirming demographics and insurance, signing consent forms, and checking in for their remote visit. Make patient questionnaires easier Most patients would rather not deal with those long questionnaires, but they often help providers detect important changes in a patient’s health. With healow CHECK-IN, patients have all the time they want to finish questionnaires well before entering the virtual waiting room. The result? Less stress on your patients, better answers for your staff, and a more productive televisit. Staff on behalf of provider A staff member may now start a scheduled virtual appointment on behalf of a provider. From the Progress Note, the staff member can click “Start Televisit” to chat with the patient, then put the call on hold until the provider is ready to join. Invite another contact Providers and patients can use text or email to invite another contact, such as a specialist, therapist, family member, or translator, to join a televisit. Once the new member joins, a notification allows the provider to accept or decline the request. With the addition of the features, the patient experience will continue to rise. If you are interested in discussing these enhancements to eClinical Works Telehealth solution, please feel free to reach out to Mark Lazar at [email protected] Mark Lazar, Director of Corporate Affairs |
| MEDICAL MANAGEMENT UPDATES |
| HELLO, JUST A REMINDER TO ALL THE PRACTICES – April 2022 1. Global and outpatient referrals go through Medical Network One’s POD’s system (www.mednetone.net). If you need assistance uploading a referral, send a fax to 248-475-5777 or a secure email to [email protected]. 2. Office managers can add new members to access PODS. Have the office manager log into the site and select “Request a New Account”. Our referral specialist checks the site daily and will set up new accounts as requested. 3. All MRI’s and CT Scans go through AIM now (1-800-728-8008). 4. All PT/OT/ST (physical/occupational/speech therapy) go through EVICORE (1-877-531-9139). Chiropractor referrals are only good until the end of the year. Initial referral is good for 30 visits and then unlimited after that. 5. Patients with BCN Advantage DO NOT need a global referral to see a specialist. They only need a referral for the procedure that they are having done (e.g. colonoscopy/EEG). 6. Diagnosis codes need to be specific. Please do not submit Z00.00 for any specialist. For example: Knee Pain Unspecified (need specific knee). – If we receive unspecified diagnoses, we will contact you for a different diagnosis. 7. Any practice that cannot get on to PODS and needs a referral completed can print this referral form, fill it out, and fax it to 248-475-5777. If you have any questions, please contact us, we are here for you. Stay Safe!!! Christina Pourcho, Referral Specialist Phone: 248-475-4759 Fax: 248-475-5777 Email [email protected] (SECURE EMAIL ONLY) |
| Quality Improvement |
| Welcome to the quality improvement portion of the newsletter. We will be going over important updates to quality measures and changes that may occur throughout the year. This month we will be touching on Blue Cross Blue Shield switching from web-DENIS over to a new service/tool. The company Availity provides a multi-payer portal, called Availity Essentials. In the coming months, Blue Cross Blue Shield will be transitioning from web-DENIS over to using Availity Essentials. Availity Essentials is also used by other payers in the state of Michigan, including Aetna, Humana, and Molina. So, if you already have an account and are setup on Availity with them, there is no new logins that need to be created. However, if you, or someone at your office, do not already have an Availity login, then it will be extremely important to get them created in the coming months; web-DENIS will be shutting down sometime in June. While the current web-DENIS system will no longer be available, all the functionality that was found in web-DENIS will be available through the Availity Essentials tool and should not look any different; just the new accounts will need to be created. There are a lot of great resources available that detail what needs to be done on the provider side. If you have not already seen some of these documents sent directly to you, please reach out. We are happy to forward along FAQs and other documents, while assisting you in this process. If you have any questions, do not hesitate to reach out! Andrew Kurecka, Director of Innovation and Research Improvement |
| Human Resources |
| Society for Human Resource Management (SHRM) in collaboration with other organizations, released a report about the state of learning and development (L&D). Two years into the pandemic and with the Great Resignation – the biggest talent shortage in decades – in full swing, two surveys conducted among HR managers and employees in the U.S. reveal the ways companies are addressing the talent shortage, skills gaps, and the training roadblocks employees face. According to the survey, 67% of HR managers will have an increased L&D budget in 2022. 46% already have specific training in place for new graduates who are entering the workforce, and 42% offer training to support the re-entry of formerly retired employees. The report also uncovers the rising importance of mental health and well-being training for the employee experience in the post-pandemic workplace. 72% of HR managers would invest in mental health and well-being training if they had a higher L&D budget, and 77% of HR managers are likely to focus on life skills within the next 12 months. Key findings from the survey include: § 55% of employees say they need additional training to perform better in their roles. § 38% of employees advise companies to align training with job responsibilities, 32% believe it’s important to update training content more frequently, and 32% believe training should be more social. § One in two employees is pursuing learning opportunities on their own, outside of training at work. § Self-management will be among the top in-demand skills in 2022, with 83% of organizations focusing training initiatives on it. Robert Pejas, Director of Human Resources |
| Blue Cross Complete has entered into an agreement with National Imaging Associates Inc., a subsidiary of Magellan Health, to manage diagnostic imaging services such as MRI/CT/PET scans. Please see the attached flyer from BCBS for additional information. CLICK HERE. |
