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Medical Management
 HELLO, JUST A REMINDER TO ALL THE PRACTICES – November 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 cpourcho@mednetone.net.
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  cpourcho@mednetone.net (SECURE EMAIL ONLY)
Care Management
Medical Network One continues to assist practices with opportunities for improving patient experience of care.  Several practices have been participating in BCBSM Patient Experience of Care (PEC) initiative to increase patient satisfaction with care access, lab and test results, and streamlining appointments.  Patient satisfaction is measured via the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) survey.  Although CG CAHPS surveys provide a standardized way to collect and measure patient satisfaction and experience of care, practices can begin collecting feedback with more simplistic survey tools.  Collecting and analyzing data allows practices and providers to focus on healthcare quality and aspects of healthcare experience that patients may find important.  The following PCMH capabilities are specific to patient satisfaction.  MNO practice coaches will reach out to practices to provide support implementing the following capabilities:

4.4 
PCMH/PCMH-N patient satisfaction/office efficiency measures are systematically administered 

PCP Guidelines: 
a. Patient satisfaction and office efficiency measures (e.g., patient waiting time to obtain 
appointment, office visit cycle time, percentage of no-show appointments) are monitored on an 
ongoing basis 

i. Measures must be derived from surveys conducted by the office or from information 
provided by health plans, the PO, or other sources Surveys do not need to focus on a specific chronic condition, provided they capture information relevant to all chronic conditions, such as asking about whether the primary practitioner discusses health care goals, diet and exercise, and supports the patient in achieving health management goals Surveys should be conducted annually at minimum ii. Reference information at Agency for Healthcare Research and Quality about CAHPS: 
http://www.ahrq.gov/cahps/index.html 

iii. Results must be quantified, aggregated, and tracked over time 

b. If office is not meeting standards for patient-centered care, follow-up occurs (e.g., process 
improvements are implemented; efficiencies are improved; practice culture is addressed) 
tracked over time Discuss follow-up process with the results   
4.23 
Practice has engaged in root cause analysis of any areas where there are significant opportunities 
for improvement in patient experience of care using tested methods such as Journey Mapping or 

LEAN techniques 
PCP and Specialist Guidelines: 
a. Practice is currently or has within the past two years engaged in analysis of patient experience of 
care, using established methods such as Journey Mapping or LEAN 

b. Steps to address areas of concern or dissatisfaction have been identified. 
BCBSM PCMH and PCMH-N Interpretive Guidelines 20202021-20212022 54 

Required for PCMH Designation: NO Predicate Logic: n/a 

PCMH Validation Notes for Site Visits Describe how process improvement projects are identified. What tools are used to determine an opportunity? Describe the team involved in process improvement projects. Provide example of project template – A3, PDCA, etc. Provide example of metrics, tracking, and outcomes.  
For questions regarding the specific PCMH capabilities, please contact your practice coach.  Please contact James DeWitte at jdewitte@mednetone.net for general information about experience of care.
 
Erica Ross, Clinical Services Manager
Corporate Affairs
A one patient, one record approach to EHR interoperability
eClinical Works has developed a tool called PRISM that is a health information exchange search engine.  Prisma brings together records from small clinics to large-scale hospital systems whose EHR systems participate in the Carequality and CommonWell Health alliance networks. PRISMA also aggregates patient information from insurance payers and patients’ wearable devices to promote better interoperability. With PRISMA, the days of paper forms, long waits, and phone calls are over. Before a patient arrives, your staff can create a full history for that patient with just a few clicks on a keyboard. History, medications, diagnoses, demographics, insurance, and more. It’s all there, ready for your staff and providers to focus on creating a great care experience for every patient.  If you are interested in learning more about PRISMA please feel free to reach out to Mark Lazar at  mlazar@mednetone.net

Mark Lazar, Director of Corporate Affairs
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 something that was discussed in the past: 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. Previously, Blue Cross Blue Shield started the transition 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 ASAP. Currently, web-DENIS is still partially active, but everything is being switched over the in the next couple of weeks and will no longer be accessible through the previous website method (some of which is already only available through Availity). 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
Getting point across to an audience is important.  When you lead it is crucial.
That’s when it’s even more critical to use the most powerful words.

But using the right words isn’t just important for clear communication. When managers communicate well, their employees have higher job satisfaction and a deeper level of job commitment.

These eight words are the most effective in the English language. They’re powerful words in sales, marketing, and business in general. They can help you convince employees to act, motivate them to take charge and help
 
Word 1: You
Generations of influencers have found that you is the absolute most influential word. It puts the focus on others. It shows empathy and compassion, which is at the heart of persuasion.
 
Word 2: Imagine
Imagine expands everyone’s idea of what’s possible. It provides opportunities and suggests people can skip the worries.
 
Powerful word 3: Because
Because helps logical thinkers connect cause and effect. Emotional thinkers connect feelings and logic.
Giving people reasons, connected by because, gets them to respond fast.
 
Word 4: Now
Most people want immediacy. Tell them what’s happening now, not what already took place. Tell them how they’re affected now and in the future.
 
Word 5: Believe
Believing is the first step in making something happen. When people believe in what they are a part of, they’re more likely to see how to overcome limitations.
 
Word 6: Guarantee
You can put people at ease with the word guarantee. It offers assurance in risk and security in complexity.
But be careful.  Only use it when you can 100% guarantee what you say.
 
Word 7: Act
Act is a call for urgency and is appealing because it suggests good things will happen. That will move people closer to what they want.
 
Word 8: Help
Help creates connections.
When leaders ask employees for help, they show everyone is part of the team and the leader isn’t just a figurehead. When you acknowledge help given, you recognize people’s individual value to the group’s good.
 
 Robert Pejas, Director of Human Resources
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 review the PCMH Mid-Cycle Process:BCBSM’S PCMH designation program has transitioned to a two-year designation. The PCMH Mid-Cycle Review (MCR) offers new PCP practice units the opportunity to receive designation during the PCMH off-cycle year. Practice units are eligible to be nominated by their PO if they meet the following criteria:Physicians are PGIP members in good standingPractice has at least one physician who is functioning as a PCP and at least 1 commercial PPO attributed memberPractice unit is either a new practice unit, or did not earn designation during the last PCMH full cycle reviewPhysician(s) in the practice wish to participate in BCBSM’s PCMH Designation Program and are willing to host a site visit if requested to do so by BCBSMCriteria for Receiving PCMH Mid-Cycle Review Designation:Practice is nominated ANDPractice meets the Clinical Quality metrics criteria for the commercial population with a percentile rank ≥40th percentile ANDPractice has at least 50 PCMH capabilities reported as in place ANDPractice has all 15 required capabilities reported as in placeKathryn Correll-Rice, Manager of Quality Improvement Strategy