1 WINTER ISSUE 2010/2011 New chief medical officer brings expertise in administration, research and patient care Security Health Plan of Wisconsin, Inc., has named Steven E. Szebenyi, M.D., M.M.M., as its chief medical officer. Dr. Szebenyi comes to Security Health Plan from upstate New York where he most recently served as president of a health services research organization. He has a broad background in administration, teaching, research and patient care. Board certified in internal medicine, Dr. Szebenyi practiced for 20 years in primary care internal medicine and headed the AIDS Treatment Center at Albany Medical College, Albany, New York, from He was medical director for HealthNow New York, a health insurance company covering approximately 750,000 people in the Buffalo and Albany regions of New York, from 1998 to While there, he founded and directed the Foundation for Healthy Living, a philanthropic health research foundation. Since then he founded and has served as president of a health services research/consulting firm in Valatie, New York, where he secured funding and coordinated consultants for projects aimed at improving patient safety and quality of care outcomes. Dr. Szebenyi s vast knowledge of health plan organizations and programs in the areas of finance, administration, business development, regulatory compliance, Steven E. Szebenyi, M.D. M.M.M. service and operations make him an asset to Security Health Plan, said Steve Youso, chief administrative officer at Security Health Plan. We are fortunate to have Dr. Szebenyi as part of our team. Dr. Szebenyi earned his medical degree from The Johns Hopkins University School of Medicine, Baltimore, Maryland, and a master s of medical management from the University of Southern California Marshall School of Business, Los Angeles. He completed a residency in internal medicine at Mary Imogene Bassett Hospital, Cooperstown, New York. He holds faculty appointments at Albany Medical College, and State University of New York at Albany, School of Public Health, both in Albany, New York. The Marshfield Clinic system offers many opportunities to Security Health Plan aims to improve quality, lower costs Managing the cost of care for our members is a priority for Security Health Plan. We want to be good stewards of the premiums our customers pay, and to help members become better health care consumers. Because you are one of our providers, we want you to know about the steps we are taking to help lower costs and improve quality and how you can help. High-end imaging utilization - Like you, we want to protect our members from unnecessary imaging that can add cost and put them at risk for over exposure to radiation. Security Health Plan implemented a prior notification process for providers who do not use a decision-support tool for high-end images (MRI, CT and PET scans). By utilizing Security Health Plan s radiology decision-support tool, you can make optimal decisions regarding imaging as part of your treatment plan. Transplant Centers of Excellence - Security Health Plan, in collaboration with a team of physicians and (12/10) 2010 Security Health Plan of Wisconsin, Inc. (continued on page 2) (continued on page 2)
2 Security Health Plan aims to improve quality, lower costs (continued from cover) New chief medical officer brings expertise in administration, research and patient care (continued from cover) consultants, has identified transplant Centers of Excellence to have health care value that exceeds the norm; better outcomes at lower cost. Security Health Plan will work with you to refer members who need transplants to these facilities that are designated as Centers of Excellence. Our staff can help: guide members through the transplant process from pre-evaluation until post transplant help members understand their transplant benefits and resources coordinate services for the member with an emphasis on quality and continuity of care If you have a member who needs a transplant, contact one of our nurse care managers: Janice Fountain at or Christi Bruggeman at On behalf of our members and employer group customers who have been asking us to lower their health care costs, we want to thank you for collaborating with us on these projects. These initiatives will ensure our members receive the right care in the right place at the right time. bring all of my skills and experience together, along with the ability to participate in academics and research, and have a role in improving public health in central Wisconsin, Szebenyi said. I was impressed with the leadership at the health plan and the Clinic. There is a strong commitment to quality health care and a clear mindset and unity between Marshfield Clinic and Security Health Pan as to the direction they re going. A big push in the health care reform provisions is to increase quality, and to show improvements in patient safety and efficiency. It pushes organizations to focus on the patients and health outcomes while removing unnecessary costs. This will be challenging and will require clear thinking within Security Health Plan and our entire network of providers. I look forward to contributing clarity to these projects, Dr. Szebenyi said. Security Health Plan ranks among nation s best for sixth straight year Thanks in large part to our providers, Advocare plans from Security Health Plan of Wisconsin, Inc. have been rated first in Wisconsin and sixth best nationally among more than 300 Medicare plans in the nation, according to the latest rankings by the National Committee for Quality Assurance (NCQA).* In addition, Security Health Plan was ranked the 36th best among more than 227 private health plans in the nation. This was the sixth consecutive year Security Health Plan has been ranked.** Security Health Plan s outstanding rankings are the result of the strong partnership we have with our providers. Your dedication to providing the highest-quality care to our members played a key role in helping us achieve these rankings. Thank you. * NCQA s Health Insurance Plan Rankings Private and Medicare. ** U.S. News/NCQA America s Best Health Insurance Plans (annual). America s Best Health Insurance Plans is a trademark of U.S. News & World Report. Security Health Plan Provider News 2 Winter Issue
3 Security Health Online enhanced We ve made it easier to get information about your patients coverage online. Many providers who regularly use Security Health Online have given us suggestions on ways we could improve our provider portal. We listened to your specific requests and are excited to announce enhancements that will make accessing your patients benefit and health information easier. New features will make your job easier 1. Additional information added to the Eligibility and Benefit Lookup section gives you a better understanding of member benefits. View your patients Schedules of Benefits to find out-of-pocket costs for services. Check whether or not patients have pre-existing condition waiting periods. Find out if you are classified as affiliated, non-affiliated, level 1 or 2 in Security Health Plan s network, based on member benefits. 2. Improved search capabilities under Select Member allow you to access member information quicker. 3. Provider statements now open in a new screen to make viewing and comparing statements easier. 4. Announcements button allows you to quickly access important news from Security Health Plan. Online demo explains how to use portal Learn how the provider portal can help you quickly find your patients information and stay up-to-date with Security Health Plan news by viewing our online demo. Visit our website, click on Providers, then Security Health Online Home. Save time; use the provider portal Log on to Security Health Online instead of calling Customer Service the next time you need to access important patient benefit information. It will reduce your time for answers. Access your patients information when you need it, 24 hours a day in convenient, secure way.
4 Improved medical management processes Security Health Plan implemented three new processes in December 2010 for utilization management activities. We are confident these processes will improve outcomes now and in the long term. The processes include: a web-based, decisionsupport tool to help participating providers select the appropriate high-end imaging tests for their patients, software that centralizes patients demographic, medication and condition information to promote coordination among all members of the care management and support team, and software that identifies and monitors chronic diseases to enable the most appropriate and timely treatment. We ask for your understanding and patience as we work to enhance our efficiency and yours with the new processes. Attention home health agencies: Online prior authorizations provide quicker responses Online prior authorizations take the guess work out of scheduling in-home care visits. Scheduling in-home care such as nursing services or physical therapy is timeconsuming and complicated. Save time by entering prior authorization requests on the Security Health Online provider portal. You ll receive a start-ofcare date and approval for the number of visits much more quickly than with paper requests. The portal will show you right away if your request has been approved, which means you ll spend less time rescheduling appointments. Logon today to begin making online Security Health Plan prior authorizations work for you. ID cards provide important information for self-funded groups Security Administrative Services (part of Security Health Plan), is a third party administrator which provides health care coverage to self-funded employer groups. With a self-funded plan, employers can choose to purchase medical management services such as utilization management, case management, disease management and/ or wellness from Security Administrative Services or from another vendor. Checking the member s ID card will provide you with important information, including which medical procedures may need pre-certification/predetermination and what medical management phone numbers to use. Security Health Plan Provider News 3 Winter Issue
5 Featured inside: New chief medical officer brings expertise in administration, research and patient care Security Health Plan aims to improve quality, lower costs Security Health Plan ranks among nation s best for sixth straight year Improved medical management processes Attention home health agencies: Online prior authorizations provide quicker responses ID cards provide important information for self-funded groups Security Health Online enhanced Provider News: Security Health Plan s Provider News is intended to keep providers in our network current with the latest developments in group and direct pay, Medicare, Medicaid and other managed care programs. Provider News functions to assist providers with the important task of extending high-quality health care to Security Health Plan members by providing informative and timely articles. If there is a topic you would like addressed in Provider News, please contact Katie Olszewski, editor, at , ext Saint Joseph Avenue P.O. Box 8000 Marshfield, WI Nonprofit Org. U.S. Postage P A I D Security Health Plan of Wisconsin, Inc.
The essential guide to health care quality 1 NCQA Table of Contents INTRODUCTION A Letter from Margaret E. O Kane....................................... 4 CHAPTER 1 What Is Health Care Quality?.......................................
Thank you for choosing CNA WORKERS COMPENSATION As every employer knows, workers compensation is a significant cost of doing business, not only in actual dollars, but in lost work days and reduced productivity.
A Consumer Guide to Understanding Health Plan Networks Table of Contents steps you can take to understand your health plan s provider network pg 4 What a provider network is pg 8 Many people are now shopping
Ontario s Action Plan For Health Care Better patient care through better value from our health care dollars ontario.ca/health Ontario s Action Plan For Health Care Better patient care through better value
global workplace solutions Meet us, join us, grow with us Contents Welcome letter from Stephen N. Terrano 1 Working for Johnson Controls 2 Opportunity abounds 4 What does this mean for me and my career?
Effective Jan. 1, 2015 2015 STRS Ohio Health Care Program Guide 2 www.strsoh.org Welcome Thank you for your interest in the STRS Ohio Health Care Program. We understand that choosing a health care plan
Volume 5, Number 3 June 2012 Quarterly circulation approximately 222,000 to all RNs, LPNs, and student nurses in Ohio. Nursing Process and Critical Thinking: Ohio Board of Nursing Law and Rules Developed
Summary of Responses to an Industry RFI Regarding a Role for CMS with Personal Health Records Table of Contents EXECUTIVE SUMMARY... 4 1. INTRODUCTON... 7 2. CMS ROLE WITH PHRs... 9 What PHR functionalities
MED3OOO White Paper The Crucial Role of the Nurse in EHR Implementation By Jay Anders, M.D., Chief Medical Information Officer, and Terry Daly, R.N., Vice President of Clinical Systems As residents coming
Implementing Comprehensive Online Programs that Improve Student and Institutional Outcomes in Higher Education Introduction: State of Online Learning Market Online learning continues to provide unprecedented,
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Important information about your health benefits Aetna Select SM Aetna Select SM Open Access Elect Choice Aetna
Getting started with Medicare. Medicare Made Clear TM Get Answers: Medicare Education Look inside to: Understand the difference between Medicare plans Compare plans and choose the right one for you See
A Chance to Change Foundation Annual Performance Report for July 2013-June 2014 A Chance to Change Foundation (ACTC) has reviewed the agency s performance, in order to assess the quality of programming
State of Wisconsin Group Health Insurance Program for State of Wisconsin Employees Retired State of Wisconsin Employees (Annuitants) Members with Continuation Coverage (Continuants) UW Graduate Assistants
Developing an Effective Health Care Workforce Planning Model Contents Executive Summary...1 Getting Started with a Workforce Planning Model...2 Data Collecting, Understanding, and Using...3 Strategy Understanding
For people with HIV and/or hepatitis C and those seeking PrEP How to choose a health plan in Covered California: Do it before February 15, 2015! CONTRIBUTORS: Project Inform, APLA Health & Wellness, San
Magellan Healthcare, Inc. * 2015 Handbook for National Provider Network *In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California,
Let us help you choose the health insurance plan that fits you best Call 855-372-1212, visit bcbsok.com or contact an independent Blue Cross and Blue Shield of Oklahoma agent to get a quote today. Life
PARITY TOOLKIT FOR ADDICTION & MENTAL HEALTH CONSUMERS, PROVIDERS & SIMPLFYING THE APPEALS PROCESS: STRATEGIES FOR WINNING DISPUTES WITH YOUR HEALTH PLAN ADVOCATES SIMPLIFYING THE APPEALS PROCESS: STRATEGIES
Engaging Building Expanding A n N B C C E D P P a r t n e r s h i p D e v e l o p m e n t T o o l k i t M a r c h 2 0 1 1 Dear Colleagues: As I reflect on the past 20 years of the Centers for Disease Control
Partnering With Your Transplant Team The Patient s Guide to Transplantation U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration This booklet was prepared for the Health
GUIDING TRANSFORMATION: HOW MEDICAL PRACTICES CAN BECOME PATIENT-CENTERED MEDICAL HOMES Edward H. Wagner, Katie Coleman, Robert J. Reid, Kathryn Phillips, and Jonathan R. Sugarman February 2012 ABSTRACT:
Advanced Techniques for Work Search Target your work search Develop your network Market yourself effectively Stand out in an interview Government Career Practitioners This workbook was developed to help
Workplace Wellness Programs Study Case Studies Summary Report Contract Number: DOLJ089327414 Prepared for: Office of Policy and Research Employee Benefits Security Administration Department of Labor Office
2015 TRAINING CATALOG Table of Contents Three Easy Ways to Register... 2 About CAI Benefits of Membership... 4 Training Philosophy... 5 Learning and Development Team... 6 What s New for 2015... 9 Alternative
Health Insurance Companies and Plan Rates for 2016 Keeping the Individual Market in California Affordable (preliminary rates) July 27, About Covered California TM Covered California is the state s marketplace
M.S. Degree Program in Human Resources (MSHR) Human Services Department College of Education & Allied Professions 2015 ACADEMIC PROGRAM REVIEW: RESPONSE TO PROGRAM REVIEW STANDARDS Program Director: Dr.