Provider Insider

Issue 9

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Leadership Message

Greetings and happy 2021!  We have a lot to bring you in this new year, and “new” is the operative word. In this edition of our newsletter, you will:

  • Learn about the new name for our network.
  • Meet our newest team members.
  • Be introduced to new educational videos that will meet the new requirements of the single scorecard.
  • Learn of new value-based programs in our portfolio.

 

As successful as we were in 2020, achieving shared savings in all of our programs, we look forward to an even greater story to tell in 2021, thanks to all of you.

 

Finally, on a personal note, I want to give special thanks to Paul Staley, our director of network engagement. Paul is leaving us on January 31 to enjoy a well-deserved retirement. Paul was instrumental in building our network from its inception and energizing it with his knowledge, experience and his passion. Though he will be truly missed, we wish him all the best in his new endeavors, whatever they may be.

 

Austin Bailey, MD

Introducing UCHealth Coordinated Care Colorado

On January 1, we renamed the network UCHealth Coordinated Care Colorado (C3) to formally acknowledge our significant transformation and growth. As you know, these changes have fundamentally impacted every aspect of our organization and set us on a trajectory for even greater success in our value-based work.

 

No longer a fledgling network, today C3 offers members:

  • A centralized transformation team including care management and clinical pharmacy resources.
  • Dedicated data analysts and a robust claims warehouse.
  • Six competitive commercial and Medicare Advantage value-based contracts with a seventh contract in negotiations.
  • A single scorecard to fully integrate all provider groups, measure performance singularly across all programs and financially compensate practices based on their overall score.
  • Diverse physician-led governance structure.

 

And there’s much more on the horizon. Welcome to C3.

Transformation Updates

We would like to introduce to you Managers of Practice Engagement and Transformation Christy Howell and Katie Woodward, who have many combined years of experience assisting groups in quality and process improvement, patient-centered medical home support and value-based care. As you embark on the inaugural year of the Single Scorecard, they will continue to support your teams in activities aimed at earning shared savings and providing the best care for your patients.

 

Single Scorecard

C3 created a single scorecard to synthesize information across payers and programs, and allow for the universal tracking and reporting of performance at the TIN level. The scorecard officially launched in January 2021, and provider participation is the key to earning the maximum potential shared savings next year. The keys to success for all of these agreements is appropriate coding practices, improvement in quality scores, care gap closure and total cost of care reduction. We will help you identify initiatives and workflow processes to achieve these goals.

 

Education Series

The first videos in our education series have been published and are available for viewing. As approved by the clinical committee, viewing of these videos will count toward single scorecard goals and may also count toward CME credits for interested providers. After watching each video, please complete the corresponding survey to receive single scorecard credit. To access these videos, please use the links below:

 

*Viewing of these videos is your key to success on the new Single Scorecard. While not required, watching “Appropriate Documentation of Patient Complexity” and “Value-based Primary Care” will yield your practice more shared savings from the “Commitment” portion of the scorecard.

Contract Updates

We are excited for all of the value-based payer agreements in place for calendar year 2021. If anyone has questions regarding the agreements or your participation, please contact Dr. Bailey.

  • Anthem Commercial – Cooperative Care
  • Anthem Medicare Advantage
  • Cigna Commercial – COVID Care
  • Humana Medicare Advantage (limited participation)
  • UnitedHealthcare Commercial
  • UnitedHealthcare Medicare Advantage

Cigna Paying for TOC Codes Beginning January 17, 2021

Cigna knows how important it is to support providers in the important work of transition of care, so beginning Jan. 17, they will begin reimbursement for the Transitional Care Management CPT codes 99495 and 99496. If you are interested in learning more on utilizing these codes or how the C3 care management team can support you in using these codes, please contact Dawn Morrissey.

UnitedHealthcare MA Annual Wellness Visit Incentive Program

As you are aware, UCHealth Coordinated Care Colorado (C3) has entered into an ACO agreement with UnitedHealthcare Medicare Advantage that includes annual shared savings and stars bonus opportunities. We are pleased to announce that C3 will also offer an annual wellness visit incentive program for performance year 2021, in conjunction with the UnitedHealthcare MA contract, in order to jump-start performance in this new agreement.

From 1/1/2021–12/31/2021, C3 will provide an additional incentive payment for the completion of an annual wellness visit for each attributed UnitedHealthcare MA patient. This payment will be paid quarterly and is in addition to your regular fee-for-service reimbursement for these services.

Eligibility will be determined by UnitedHealthcare Medicare Advantage as noted with a completed Annual Care Visit (ACV) and includes visit types billed as G0402, G4038-G4039, and any other codes that qualify as UnitedHealthcare Medicare Advantage ACV.

Please see the attached PDF for more information or contact Dawn Kilgore, senior director of finance, to learn more.

Cigna Paying for TOC Codes Beginning January 17, 2021

Cigna knows how important it is to support providers in the important work of transition of care, so beginning Jan. 17, they will begin reimbursement for the Transitional Care Management CPT codes 99495 and 99496. If you are interested in learning more on utilizing these codes or how the C3 care management team can support you in using these codes, please contact Dawn Morrissey.

Pharmacy Integration: Strategies to Optimize Medication Adherence

Introduction

Poor medication adherence is a common issue in the United States. Lack of adherence to medications caused approximately 125,000 deaths, at least 10% of hospitalizations, and cost the U.S. health care system $289 billion in 2009.1,2 The Centers for Medicare and Medicaid Services (CMS) through Medicare Advantage plans and the CMS Star Rating program offer incentives to optimize medication adherence. These incentives are particularly advantageous for participants in value-based programs. Currently, there are limited studies outlining the best way to approach patients with nonadherence.

 

Population Health Approach

Given the lack of published data, UCHealth Coordinated Care Colorado (C3) has been working on a multidisciplinary workflow, utilizing population health specialists, clinical pharmacists and nurses to improve the process for identifying and outreaching patients who are identified by value-based programs as nonadherent to their medications.

A pilot program was completed October 2020 through December 2020. During this time, approximately 150 patients in a Medicare Advantage value-based program were identified as nonadherent to an antihypertensive, an oral antidiabetic or a statin medication. The medical records for these patients were reviewed and outreach was completed when appropriate. The majority of patients who were reached by phone were not able to identify a cause for missing their medication. Some patients described difficulty affording medication, and some described choosing to only pay for medication deemed essential.  Some patients were hoping to synchronize their medication refills to limit the number of trips to the pharmacy, and had therefore delayed filling all prescriptions.

Challenges to completing outreach in a timely and effective manner were identified. Patients frequently wanted to discuss additional health concerns besides medication nonadherence; it was often difficult to get ahold of patients even after two attempts by phone; and despite having access to claims data through the electronic health record, there were still gaps in available refill data.

The pilot program provided important findings to improve future medication adherence outreach. Starting in 2021, C3 will begin outreaching patients who were nonadherent during the 2020 plan year, as these patients are at high risk for nonadherence again.

What You Can Do to Improve Medication Adherence

Prescribing a 90-day supply of medication for chronic disease control is one of the most important strategies to reduce nonadherence. This increases the amount of medication patients have on hand and limits the number of trips patients need to take to the pharmacy.

A 2012 systematic review identified additional evidence-based strategies to improve medication adherence.2 Several of these strategies are outlined in Table 1.

Table 1:  Evidence-based strategies to optimize medication adherence2
HypertensionBlister packing, involving case management, and education with behavioral support
Heart failureReminder calls, pharmacist-led multicomponent interventions, education with behavioral management, and case management involvement
DepressionCase management involvement and collaborative care
AsthmaSelf-management and shared decision-making
DiabetesCare coordination and collaborative care

Conclusion

Medication nonadherence can result in increased hospitalizations, morbidity, and mortality, as well as increased costs to the health care system. C3 is currently working on improving the medication adherence process through a multidisciplinary process. Providers can improve medication adherence through multiple medication interventions, and most importantly, by prescribing a 90-day supply for medications used to treat chronic diseases.

References:

  1. National Community Pharmacists Association. Medication Adherence in America: A National Report 2013. Alexandria, VA; National Community Pharmacists Association; 2013. Available from: ncpanet.org/pdf/reportcard/adherencereportcard_abridged.pdf. Accessed December 11, 2013.
  2. Viswanathan M., Golin C.E., Jones C.D., et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012 Dec. 4;157(11):785-95.

Staff Updates

Amy Scanlan, MD

I am delighted to announce that Amy Scanlan, MD will be joining UCHealth Coordinated Care Colorado as Medical Director beginning in February 2021. She will begin onboarding with Dr. Austin Bailey in February and will continue to meet with network practices and the various UCHealth teams through April. Please join me in welcoming her to our team.

Bringing outstanding experience, expertise, leadership and energy, Dr. Scanlan has served for the past five years at SCL Health in a few different capacities: Medical Director of Quality and Innovation, Medical Director of Primary Care, and most recently as Medical Director of Recruitment and Provider Experience.

She has continued to see her patients at SCL Cherry Creek Family Medicine, where she moved in 2006 after practicing with New West Physicians for seven years. Dr. Scanlan served on numerous SCL Health committees spanning quality and credentialing, and also participated in Aetna’s credentialing committee for the western U.S. She is very familiar with value-based care models, having been part of a PHP ACO practice for the past ten years, as well as participating on the PHP Practice Performance and Standards Committee, and serving on the PPP board.

Dr. Scanlan received a Bachelor of Arts with Honors in Science in Society from Wesleyan University in Connecticut. She obtained her medical degree from Case Western Reserve University in Cleveland where she received the Kiwala Award for Research in Family Medicine. Her residency was completed at St. Anthony Family Medicine Residency program in Denver. She has been in practice for over twenty years. She is currently board certified by the American Board of Family Medicine and NCQA certified in diabetes.

Dr. Scanlan’s professional and personal interests include physician wellness, team-based care, reading, cooking, running, hiking and spending time with her husband and two children. We couldn’t be happier to have Dr. Scanlan on our team; please be sure to extend a warm welcome to her!

Tamara Ellis

Tamara is a graduate of Georgetown University where she earned her Bachelor of Science in Nursing in 1994. She spent 15 years working for Cone Health in Greensboro, N.C., in the areas of labor and delivery, ambulatory surgery, trauma and renal failure. Tamara obtained her Master of Business Administration with a Health Care focus in 2011. In 2012, she was recruited by UCHealth to come to Colorado as the trauma program manager at Medical Center of the Rockies.

Since starting with UCHealth in January 2013, Tamara has worked in trauma, ambulatory surgery, and most recently as the regulatory and quality improvement specialist for the UCHealth medical group. During her four-and-a-half-year tenure with the medical group, Tamara has been the MIPS and quality payment program expert, the program manager for risk coding and HCCs, and worked on various other quality- and value-based contract programs. With Tamara’s expertise, the medical group has seen improvements in HCC recapture rates and she has provided risk coding education to providers and clinics. In September 2020, Tamara obtained her certification in risk adjustment coding.

Tamara lives in Windsor, Colorado with her two daughters, Olivia (15) and Abigail (12), 3 dogs, and a grand-guinea pig. She loves living in Colorado and her favorite color is purple. 

Keri Hogan, PharmD, BCACP, CLS

Keri Hogan is a clinical pharmacist providing comprehensive medication management support for UCHealth Coordinated Care Colorado and UCHealth Medical Group.

Dr. Hogan is a residency trained, board certified ambulatory care pharmacist. She previously served as a clinical pharmacist in an internal medicine clinic at a comprehensive academic medical center for just over a year, and as a clinical pharmacist in a cardiovascular risk reduction service at an integrated health plan for seven years. In her prior roles, Dr. Hogan gained expertise in implementing interventions to improve medication related quality metrics and performing comprehensive medication reviews to reduce adverse drug events.

In her role as a clinical pharmacist in population health, Dr. Hogan will be focusing on medication management to improve quality, reduce cost and enhance the patient and provider experience.

Christy Howell

Christy returned to a career in health care in 2014 by joining UCHealth as a care coordinator with a registered medical assistant (RMA) certification through American Medical Technologists (AMT) while completing a BS in Health Care Administration. She supported foundational practice transformation activities of the participating Medical Group in the Centers for Medicare & Medicaid Services (CMS) innovation model, Comprehensive Primary Care initiative (CPCi) and then, the advanced primary care medical home model, CPC Plus (CPC+).

She transitioned to the Transformation & Innovation team in 2016 as a practice transformation coordinator (PTC). Through the process of education, training, study, taking exams, and leading UCHealth Medical Group primary care practices successfully through the National Committee for Quality Assurance Patient-Centered Medical Home (NCQA PCMH) recognition program, she earned the PCMH Content Expert Certification (PCMH CCE).

During the national shift in health care toward value-based models, rewarding health care delivery providers for positive patient outcomes and away from fee for service, her interest in population health and accountable care grew. With an aligned interest, and strong advocacy by her manager and others, she graduated from Johns Hopkins Bloomberg School of Public Health with a Master of Applied Science in Population Health Management in 2019.

Recognized for her work in value-based programs, she was invited to join the clinically integrated network team as a population health project manager. Along with countless highly skilled colleagues, she continues to support interdisciplinary teams as she takes on this new role with C3. She is committed to building long-lasting and meaningful relationships within the communities served, as well as driving improvements in care delivery that result in shared savings to the practices.

Heather Hubach, NCMA

Heather joined UCHealth Coordinated Care Colorado as a population health specialist in November 2020 and is excited to learn the multitude of ways population health can contribute to taking care of patients and supporting individual practices.

Prior to her current role, she spent a year doing care management for UCHealth Medical Group as a health coordinator, and five years as a medical assistant in a primary care redesign clinic at UCHealth Internal Medicine – Snow Mesa.

Outside of work, Heather enjoys going on bike rides, attempting craft projects, and watching her kids play sports.

Alfonso Muñoz, LPN

Alfonso “Fonzi” Muñoz is a licensed practical nurse with over 10 years of experience in multiple medical specialties including family practice, internal medicine, infectious disease, home health, corrections and adult day care. In 2009, he graduated from the Odessa College nursing program in Odessa, TX where he was awarded for clinical excellence. Throughout his roles he has worked with vastly different types of patients and found the best approach to meet all their individual needs. He has also been utilized at all previous positions for office management, new staff training, administrative assistance and data collection. Alfonso believes in treating patients the same way he would his own family and takes pride in teamwork to get the job done. 

In October 2020, Alfonso joined UCHealth Coordinated Care Colorado to assist patients with transitions of care following hospitalizations or emergency department visits; compile and distribute discharge reports; and help meet gaps in care for payers and providers.

Michael Uhrman, BSN, RN, CCM

Michael has 32 years of professional nursing experience, 24 years in acute care in Wisconsin and Colorado, and 8 years of care management in both inpatient and outpatient settings. His bedside nursing care and experience was divided between 10 years medical/surgical nursing and 14 years as an ICU charge nurse.

Michael earned his Bachelor of Science in Nursing degree from Carroll/Columbia College of Nursing in Waukesha, Wisconsin. He is a certified case manager. Prior to joining UCHealth Coordinated Care Colorado, he worked at UCHealth Medical Group for 4.5 years to develop a care management relationship with the Cigna value-based contract team, and was the RN care manager at Windsor Family Medicine. 

Michael has a strong passion to provide patients with the best care experience and resources available to them to promote good health. His free time is spent traveling, gardening and with family and friends.

Katie Woodward

After earning her Bachelor of Science in Public Health and Master of Health Administration from Tulane University, Kathryn (Katie) Woodward began working as an Administrative Fellow at SSM Health. During her time at SSM Health, she focused on aligning the system’s hospitals, ambulatory clinics, medical group, and health plan to promote systems thinking and improve population health outcomes. As a result, Katie helped drive down the costs of care for the high-risk diabetic population, increase utilization of mid-level providers in specialty care, and improve community programming for new and expectant mothers.

In December 2019, Katie returned to her home state and began working at UCHealth as a project manager. In her short time with the organization, Katie worked on a variety of projects and teams supporting efforts to enhance scheduling decision trees, expand concierge pharmacy care in ambulatory clinics, and open a new system fulfilment pharmacy.

Outside of work, you can find Katie taking advantage of Colorado’s nature by either camping, hiking or skiing, depending on the season.

To learn more about our integrated network, please contact us.

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