Provider Newsletter | Issue 28

Provider Icon

The Alliance releases 2022-2026 Strategic Plan

The past two years of the pandemic have been filled with challenges and uncertainty. We are grateful to all our contracted providers for your ongoing efforts to support Alliance members.

Looking ahead, we are eager to share our 2022-2026 Strategic Plan with you, and to embark on this important work together.

The Strategic Plan was developed with the input of Alliance members, community partners, our Board and advisory committees, and Alliance staff members. Over the next five years, we will focus on two key areas:

  • Health equity.
  • Person-centered delivery system transformation.

As we ensure our members have access to high quality health care services, we will focus our innovations on:

  • Fostering children’s health.
  • Providing access to a network characterized by cultural humility that reflects the diversity of the Alliance’s membership.
  • Improving the behavioral health system and model of care for people with complex conditions.

Providers play a vital role in these efforts! We are committed to providing support for providers and office staff so you can be well-equipped to serve Alliance members.

Provider resources include:

  • Personalized support: Connect with your Provider Relations Representative, who can address your concerns and answer your questions about claims, authorizations, referrals and member services.
  • Specialized training: We offer training in topics like claims, quality improvement, practice coaching, cultural and linguistic services, and the Provider Portal.
  • Care-Based Incentive (CBI) Program: The Alliance offers care-based incentives for primary care providers (PCPs) to improve member experience and reduce disparities.
  • Many other resources—including news, forms, claims information and provider policies and procedures — are available in the provider resources section of our website.

We are here for you – please let Provider Services know how we can support you and your practice! You can call us at 800-700-3874, ext. 5504.

To learn more about our strategic priorities and the environmental factors considered in the planning process, visit our website.

Thank you for your continued collaboration in providing accessible, quality health care guided by local innovation!

Medical record requests have begun for HEDIS

The annual Healthcare Effectiveness Data and Information Set (HEDIS) season is underway! As a reminder, KDJ Associates, Inc. will request patient medical records from Alliance providers between February and May 2022.

The following HEDIS measures will be reviewed this year:

  • Childhood Immunization Status.
  • Immunizations for Adolescents.
  • Cervical Cancer Screening.
  • Prenatal and Postpartum Care.
  • Controlling High Blood Pressure.
  • Comprehensive Diabetes Care.
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: BMI Assessment, Nutrition, and Physical Activity.

Visit our HEDIS Resources page for tip sheets, an FAQ and other support materials.

Questions? Contact Britta Vigurs, Quality Improvement Project Specialist at 831-332-8283 or at [email protected].

Postpartum Medi-Cal eligibility extension effective April 1

The Department of Health Care Services (DHCS) will extend the Medi-Cal postpartum care period and scope of coverage for currently eligible and newly eligible pregnant individuals, effective April 1, 2022.

The eligibility extension broadens the scope of coverage to full-scope benefits during both the pregnancy and postpartum periods. The postpartum coverage period for individuals receiving pregnancy-related and postpartum care services will expand to include an additional ten months of Medi-Cal coverage following the current 60-day postpartum period, for a total of 12 months.

For more information, please contact Provider Relations at 800-700-3874, ext. 5504.

March 3 webinar: screening for adverse childhood experiences (ACEs)

The California Department of Health Care Services is urging primary care teams to implement screening for adverse childhood experiences. Join the Alliance and Health Improvement Partnership (HIP) of Santa Cruz County for an ACEs screening webinar for primary care offices.

ACEs Screening: Promoting Resilience for All

Thursday, March 3, 2022 | 7:30-9 a.m.

  • Featured speaker: Susan Swick, MD, MPH, executive director of Ohana.
  • 1.5 CME/CEU credits will be offered, pending approval.
  • Read the full course description.

Register via Zoom