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Provider Digest | Issue 10

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Seeking your participation: Provider Appointment Availability Survey

If you haven’t already completed it, your participation is needed in our annual Provider Appointment Availability Survey (PAAS). The second set of survey calls and emails will be administered between Oct. 17 and Nov. 18.

The PAAS assesses our network’s ability to provide care within timely access standards. Please encourage your reception staff to participate in survey calls.

For more information on the PAAS, including format, timely access guidelines and best practices, please review our previous PAAS announcement in the Sept. 1 Provider Digest.

Thank you for your participation in this year’s PAAS. If you have questions, please contact an Alliance Provider Relations representative at 800-700-3874, ext. 5504.

Watch the recorded 2023 Care-Based Incentive (CBI) workshop

On Sept. 16, 2022, the Alliance hosted our annual Care-Based Incentive (CBI) workshop.

If you missed it or want to re-watch the workshop, the recording is now available! You can also check out some high-level takeaways below.

Key takeaways

  • The 2022 CBI programmatic payment adjustments will occur for measures below the minimum performance level (MPL) of the 50th
  • There is a new fee-for-service (FFS) measure for providers who complete the ACEs Aware training and submit a training attestation.
  • There are several best practices for improving CBI measures, including targeted practice interventions and strategic utilization of Alliance resources.
  • Effective communication is bidirectional and tailored to address health literacy, cultural competency and language barriers. The Alliance offers access to qualified interpreters for our limited English proficiency (LEP) members.
  • We offer support to provider teams through performance review and quality improvement work. This is done through the programs like our CBI Forensics and Practice Coaching.

Visit our website to view the workshop recording, slides and FAQ sheet.

Questions about the CBI Program? Email [email protected].

Funding for ECM/CS infrastructure and capacity building

We are pleased to share a few funding opportunities for providers of Enhanced Care Management and Community Supports (ECM/CS) services. You can find more information on ECM/CS on our website.

CalAIM Incentive Payment Program

Implementation of Enhanced Care Management and Community Supports requires significant investments in care management capabilities, infrastructure, information technology and data exchange, and workforce capacity at both the managed care plan and provider levels. The DHCS CalAIM Incentive Program (IPP) supports the development of a robust Medi-Cal network to deliver ECM/CS services.

The Alliance is administering this incentive funding to support our local provider network in addressing gaps and building infrastructure and capacity for ECM/CS services. Note that IPP cannot overlap with other DHCS incentive funding for ECM/CS, such as CITED (see below).

To facilitate incentive funding, the Alliance is intaking information about infrastructure and capacity needs via the ECM/CS Certification Tool from providers who have attended a Provider Engagement Session with Alliance staff and are interested in contracting.   If you are interested and/or have questions, please email us at [email protected]

Capacity and Infrastructure Transition, Expansion and Development (CITED) Initiative

CITED is a DHCS-administered grant program that provides funding for the transition, expansion and development of ECM/CS capacity and infrastructure. CITED applicants must be contracted with a managed care plan for ECM and/or Community Supports services. Applicants are encouraged to coordinate applications with local organizations they contract with or intend to contract with to provide ECM and/or Community Supports services.

To apply for CITED funding, enviar una solicitud indicating how you intend to use the funding. Additional information is available on the sitio web del Departamento de Servicios de Cuidado de Salud (DHCS, por sus siglas en inglés).

Pharmacy department success story: Diabetes pilot program

Background

The Diabetes Medication Therapy Management (DMTM) Pilot Program is an initiative that was developed by the Alliance Pharmacy Department. Program goals focused on:

  • Helping members improve health outcomes and achieve their glycemic goals.
  • Decreasing health care costs.
  • Improving allocation of physician resources.
  • Reducing unnecessary hospitalizations.
  • Contributing to the overall health of our local community.

Over the last two years, Alliance pharmacists have collaborated with our Quality Improvement (QI) Department to conduct this pilot program in three clinics in our service areas that were interested in participating.

Methodology

Alliance pharmacists followed a process of:

  • Reviewing a selected provider’s most complex cases of members with poorly controlled diabetes.
  • Making medication recommendations.
  • Educating providers on current diabetes care guidelines and new diabetes medications.
  • Coaching providers on how to address medication non-adherence with patients using motivational interviewing techniques.

Glycated hemoglobin (A1C) lab values of ≤9% was our metric of success.

It took about six months per provider to complete this process, and we reviewed a total of 63 member cases. There were 44 members (70%) who completed the program by returning for routine lab work and follow up. There were 19 members (30%) who did not return for lab work and thus lost follow up.

Results

Among the 70% of members who returned for routine lab work and follow-up:

  • 71% (31 members) had improved control of their diabetes (decrease in A1C values).
  • Of the 31 members that had an improvement in A1C, 32% of them reached the goal of ≤9%.

The NCQA HEDIS 50th percentile goal in 2021 is less than 43.19% of members with an A1C >9%, with lower rates signifying better performance. The last clinic we worked with in 2021 started with 64% of members with uncontrolled diabetes. After 9 months working with this provider, their rate of members with uncontrolled diabetes decreased to 37%. This took them above the 75th percentile goal.

Takeaways

The success of the program is largely due to building good rapport and engagement between PCP partners and Alliance pharmacists, as well as our QI team’s efforts in managing provider expectations and encouraging outreach to get members into the office for repeat lab work. We hope that providers can learn from this pilot program and apply best practices to improve health outcomes and quality of life for patients with diabetes.

If you would like more information or if you are interested in joining the Diabetes Medication Therapy Management Pilot Program, please contact the Alliance Pharmacy Department at 831-430-5507.

Working together to improve health literacy

Patients may face challenges navigating the health care system due to a lack of health literacy, which can be a barrier to optimal health outcomes. When people have a hard time understanding how to prevent and/or manage their health conditions, they are more likely to skip their medical appointments and frequent the emergency room.

CDC defines personal 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.”

A cornerstone of health literacy is effective communication between providers and patients. That’s why the Alliance offers tools and resources for providers to build strong relationships with their patients. We also offer services including language assistance, interpreting and translation. Find more details on the Cultural and Linguistics Services page of our website.

In addition to supporting member-provider relationships, the Alliance also works hard to cultivate health literacy in every touchpoint our staff has with members. Our Your Health Matters team conducts regular bilingual community outreach to answer member questions face to face, and we ensure our health education materials utilize plain language that is at or below the sixth grade reading level. We regularly publish health literacy-focused resources for members, including information about how to talk to your doctor, how to understand health insurance terminology and how to use cultural and linguistic services.

If you have any questions about our programs or services, please call our Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

Thank you for partnering with us to pursue health equity and strengthen health literacy in our communities!