Respiratory Health Management Program

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1 Encourage women to have important screening tests Page 2 UPMC Health Plan Behavioral Health Services tear-out card Pages 5 & 6 Provider Satisfaction Survey Page 7 JULY 2008 In This Issue Cervical cancer screening Medications for rheumatoid arthritis Proper use of Modifier Always online Complex case management.. 7 Potentially harmful drugdisease interactions in the elderly UPMC HEALTH PLAN One Chatham Center 112 Washington Place Pittsburgh, PA upmchealthplan.com Provider Services: TTY Users: A PUBLICATION OF UPMC HEALTH PLAN UPMC Health Plan s Respiratory Health Management Program Because respiratory diseases are a growing health problem in America, UPMC HEALTH PLAN offers a comprehensive Respiratory Health Management program to help our members with respiratory conditions. This program serves members with chronic obstructive pulmonary disease (COPD) as well as members with asthma. The program uses a team approach. A care manager, pharmacist, behavioral health specialist, and clinical account manager one or all of them may work in collaboration with physicians to help members with asthma and COPD manage their condition. Our care managers are trained nurses who identify problems and work with the member s physician to develop treatment plans based on specific medical needs. To refer patients to the Respiratory Health Management program, call Below are some goals of the Respiratory Health Management program They are based on guidelines established by the National Heart, Lung, and Blood Institute. Increase the number of patients who visit their PCPs, allergists, or pulmonologists Increase long-term use of controller medications Did you know that you can read the current and past issues of Accountable Provider on our website? Visit the e-newsletter center at upmchealthplan.com to read the entire Accountable Provider newsletter or to sign up to receive any of our publications electronically. Increase patient satisfaction and improve quality of life Increase patients satisfaction with their medical care For patients with chronic respiratory disease, improve their ability to comfortably participate in their daily activities To refer patients to the Respiratory Health Management program, call , or fax the Health Management Referral Form provided to you by your Network Management representative. If you would like more information about this program, you can call Provider Services at or your Network Management representative. upmchealthplan.com

2 ACCOUNTABLEPROVIDER Encourage women to have important screening tests Many women do not feel comfortable talking openly to their doctors about private health matters. Physicians and their support staff, therefore, can be the key to preventive care by bringing three vital screenings chlamydia and breast and cervical cancers into the physicianpatient dialogue. Chlamydia Don t be silent about this silent disease The Centers for Disease Control and Prevention (CDC) calls chlamydia a silent disease because three-quarters of infected women and half of infected men have no symptoms. According to the CDC, chlamydia is by far the most common and the most frequently reported bacterial sexually transmitted disease in the United States, ahead of gonorrhea and syphilis. In the United States, the CDC reported more than a million new infections for Because chlamydia often comes with no telltale symptoms, the young women who most need to be screened are unlikely to bring it up to their physician or other health care staff. If you are treating a woman who is under 25 years old and has had sex, she s in the most at-risk group and should be screened for chlamydia. Girls who are sexually active in their teens may be even more susceptible to infection because their cervix has not matured. Breast cancer screening Among women in the United States, breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related deaths after lung and bronchial cancer. According to the CDC, 182,125 women had a diagnosis of breast cancer in 2002, and 41,514 died from the disease. The most encouraging CDC report points out that screening mammography can reduce mortality from breast cancer by approximately 20 to 35 percent in women aged 50 to 69 and by approximately 20 percent in women aged 40 to 49. Despite this positive news, the 2007 Behavior Risk Factor Surveillance System (BRFSS) report indicates that mammography rates continually declined from 2000 through It is vital that you encourage all women in your practice to have an annual mammogram after age 40. 2

3 upmchealthplan.com Please make sure these young women hear the facts from you and your staff: Even if they have what they think is protected sex using a condom, they can still be infected. The threats of untreated chlamydia to a woman s health include damage to reproductive organs and infertility. CDC reports indicate up to 40 percent of women with untreated chlamydia develop pelvic inflammatory disease. Chlamydia is caused by a bacteria (chlamydia trachomatis), which means that it is curable and there are medicines that can cure chlamydia sometimes in just one dose. Women infected with chlamydia are five times more likely, if exposed, to become infected with HIV. The CDC recommends an annual chlamydia screening for all women who may be at risk. The at-risk group includes sexually active women who: Are under 25 years old Are pregnant Don t consistently use barrier contraceptives Have signs of a possible cervical infection Have previously had an STD Are older women who have a new sexual Cervical cancer screening The National Cancer Institute (U.S. National Institutes of Health, reports that cervical cancer affected more than 11,000 women in the United States in An early diagnosis increases a woman s chance of being successfully treated. The Pap test is simple, routine, and the best way to find abnormal cell changes in the cervix. Found early, chances for successful treatment increase for both breast and cervical cancer. Like the young women at risk for chlamydia, the women who most need cervical cancer screenings may not bring the subject up if they re seeing you for another problem. Talk about chlamydia and breast and cervical cancer screening tests at every opportunity you have with your patients who could benefit from them. It s not only that they need to hear about screenings; they need to hear about them from you. 3

4 ACCOUNTABLEPROVIDER Medications for rheumatoid arthritis Medications called disease-modifying antirheumatic drugs (DMARDs) that can slow or sometimes prevent joint destruction are now recommended early for rheumatoid arthritis. Anyone with rheumatoid arthritis is a candidate for DMARD treatment. DMARDs can help prevent the significant joint damage that may occur in the early stages of rheumatoid arthritis. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs). Early treatment with DMARDs may significantly reduce disease severity. A separate study recommended that DMARD treatment be continued for a prolonged period of time to sustain the benefit of disease control. DMARDs can be divided into two general categories oral and biological based on how they work. Oral DMARDs are taken by mouth and are typically first line therapy. They interfere with the making or working of immune cells that cause joint inflammation. Biological DMARDs are given by injection or infusion. They are reserved for moderate to severe rheumatoid arthritis or for those who cannot tolerate the oral agents. The biological DMARDs act in several different ways to affect how immune cells work. Biological DMARDs decrease joint inflammation and damage. You may prescribe DMARDs as part of a combination therapy which may reduce the risk of side effects that can occur with higher doses. Oral medications may be combined with each other or with biological DMARDs, but biological DMARDs cannot be used with each other because there is a higher risk of infection. Studies have shown that combination therapy may be an effective way to reduce symptoms of rheumatoid arthritis, control the disease, and prevent it from getting worse. Do you know the HEDIS measures for respiratory health? 4 The Healthcare Effectiveness Data and Information Set (HEDIS), developed by the National Committee for Quality Assurance (NCQA), consists of 71 measures across 8 domains of care. Each health plan submits audited data, some of which is gathered through information taken directly from patient charts. Most information is taken from claims data. HEDIS measures address a broad range of important health issues. The following measures are for respiratory health: Use of spirometry testing in the assessment and diagnosis of COPD Pharmacotherapy management of COPD exacerbation Avoidance of antibiotic treatment in adults with acute bronchitis Use of appropriate medications for asthma We re focused on two of these important measures: Controller medications for asthma and spirometry testing for COPD. Controlling asthma through medication More than 20 million Americans suffer from asthma. Long-term medication therapy, or asthma management, can greatly improve your patients quality of life. Ask your patients if they use controller medications every day to control their asthma. If not, make sure your patients understand the importance of taking a controller medication that reduces both airway inflammation and bronchoconstriction, long-term on a daily basis. Inhaled corticosteroids (ICS) are the most effective and the preferred long-acting controllers for mild, moderate, and severe persistent asthma. They are generally safe and well tolerated at moderate doses. Asthma that is not controlled with low to moderate doses of ICS may benefit from the addition of a long-acting beta-agonist (LABA). LABA monotherapy has been linked to fatal asthma attacks and should not be used for asthma control without an ICS. Alternative agents that may be added to ICS include leukotriene modifiers or theophyllines. Spirometry test for diagnosing COPD Chronic obstructive pulmonary disease (COPD) is a lung disease in which damaged lungs make it difficult to breathe. The airways the tubes that carry air in and out of the lungs are partly obstructed. This makes it difficult to breathe air in and out. If a patient regularly experiences breathlessness, has difficulty breathing, or thinks he or she may have COPD, you should consider ordering a spirometry test. This test, a covered benefit under UPMC HEALTH PLAN S benefit programs, will help you determine the best treatment plan for your patient. If you have any questions regarding HEDIS, please contact Provider Services at or your Network Management representative.

5 The importance of coordinating care People with behavioral health disorders are often at greater risk of developing physical illnesses, and people with physical illnesses often develop a behavioral health disorder. When this occurs, it is important that they receive treatment for both their physical and behavioral health illnesses. If both are not addressed, the disorders are likely to become more severe and lead to higher morbidity and mortality rates. For this and other reasons, we encourage medical practitioners to coordinate care with behavioral health specialists to promote overall better health for their patients. Here are some facts about the connection between physical and behavioral health: Treating depression can help improve the prognosis of a co-occurring medical illness. Heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson s are all associated with depression. Individuals with both congestive heart failure (CHF) and depression have a fourfold increase in mortality compared to individuals diagnosed solely with CHF. Individuals with both chronic obstructive pulmonary disease (COPD) and depression have a threefold increase in mortality compared to individuals diagnosed solely with COPD. People who have untreated mental health issues tend to use more medical services. People who have depression are more likely than others to develop diabetes. Anxiety disorders are linked with many physical health illnesses, including epilepsy, heart disease, asthma, and diabetes. We strongly encourage you to coordinate care with other providers who are seeing your patients. As needed, please send a written report or call any other physician that you know is treating one of your patients. Coordination may help avoid duplicate assessments, procedures, or testing, and it could improve treatment outcomes as well as promote patient safety. Proper use of Modifier 79 Current CPT coding guidelines stipulate that Modifier 79 should be used only to indicate when the same physician performs an unrelated procedure within the global postoperative period. Appropriate use of Modifier 79 includes: An unrelated procedure was performed during the global postoperative period of the original procedure. Both procedures were performed by the same physician. Attachment to all procedure codes except those with XXX (global concept does not apply) in the global field of the Medicare Physician Fee Schedule Data Base (MPFSDB). For services where the global postoperative period starts the day after the procedure. Tear out this card and refer to it as needed. Inappropriate use of Modifier 79 includes the following: The procedure performed is related to the original procedure or a staged procedure. The procedure takes place after the global postoperative period has ended. Remember: Proper coding is necessary to ensure efficient, accurate, and prompt processing of claims. 5

6 The following information is available through upmchealthplan.com. PROVIDER MANUAL POLICIES AND PROCEDURES PHARMACY Formularies Prior Authorization Forms NEWS AND INFORMATION Behavioral health confidentiality Behavioral health patient safety guidelines Accountable Provider enewsletters and Updates FOR YOUR PATIENTS Health Management programs Patient Education Healthy Living Resources UPMC for Life Medicare Concierge Program Special Needs Program LINKS AND RESOURCES Domestic violence ALWAYS ONLINE6 MEDICAL MANAGEMENT Clinical guidelines* Preventive health guidelines for adults and children Medical necessity statement Medical record documentation guidelines Utilization management criteria The UM decision making process Accessing a medical director to discuss UM decisions Physician Forms QUALITY IMPROVEMENT Complaints and Grievances Process HIPAA (Health Insurance Portability and Accountability Act) privacy guidelines Member Rights and Responsibilities Quality Improvement Program information Physician-Patient Communication Guidelines Provider Accessibility Standards Provider Satisfaction Results Quality and Safety (compare hospitals for quality and safety) UPMC for Life Medicare Concierge Program Special Needs Program Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, Independent of Diagnoses or Conditions To request a hard copy of any of this information, call Provider Services at Items with an asterisk (*) include recently updated information. Toxic effects of medications and drug-related problems can adversely affect your elderly patients. Adverse drug events have been linked to preventable problems in the elderly, including depression, constipation, falls, immobility, confusion, and hip fractures. The Beers list is based on an extensive literature search and questionnaires that are evaluated by a nationally recognized expert panel of geriatricians, clinical pharmacologists, and psychopharmacologists. Following the guidelines in the Beers list may help you avoid prescribing high-risk medications for older persons. To view the Beers list, visit assn.org/ cgi/content/full/163/22/ 2716/TABLEIOI20821T1. 6

7 Clinical Guidelines on the web The Clinical Guidelines below are available at upmchealthplan.com. Select For Providers on the homepage and then Medical Management from the menu on the left. Next select Clinical Guidelines from the list. To view the Preventive Guidelines for children and adults, follow the steps above but scroll down the list until you see Preventive Health Guidelines. CARDIOLOGY Adult Cholesterol Management Hypertension Management Heart Failure Guideline Outpatient Management Cardiovascular Risk Factors and Coronary Artery Disease DIABETES Adult Diabetes* PHYSICAL/BEHAVIORAL HEALTH ADHD Depression Substance Abuse and Dependence RESPIRATORY Asthma COPD WOMEN S HEALTH Prenatal Clinical Practice Guidelines LOW BACK PAIN QUALITY INITIATIVE Program Booklet Frequently Asked Questions Primary Care or First Contact Physician Algorithm Physical Therapists and Chiropractors Algorithm Workers Compensation: Primary Care or First Contact Physician Algorithm Workers Compensation: Physical Therapy and Chiropractic Algorithm Algorithm Legend Yellow Flags Form Revised Oswestry Low Back Pain Questionnaire Fear-Avoidance Beliefs Questionnaire Chiropractic Low Back Pain Summary Sheet* PT Low Back Pain Summary Sheet* *Includes recently updated information. Complex case management Provider Satisfaction Survey UPMC HEALTH PLAN providers were recently surveyed to measure how well the Health Plan is meeting their expectations and needs. The 2007 Provider Satisfaction survey was conducted between October 2007 and January 2008 by The Myers Group, a vendor certified by the National Committee for Quality Assurance (NCQA). For the second year in a row, UPMC Health Plan outperformed its competitors in overall satisfaction. In addition, the Health Plan consistently scores above average in the areas of Network and Quality Management, as well as Customer Service. We want you to know that we constantly strive to ensure your satisfaction. Remember that your Provider Services representative is available to answer your questions and concerns. upmchealthplan.com UPMC HEALTH PLAN members who have complex medical or behavioral health conditions may benefit from additional support. UPMC HEALTH PLAN has a complex case management program that can help. This program encourages collaboration among providers who are caring for the same member. Our care managers coordinate health care services, support the physician s treatment plan, and identify gaps in care. They will educate the member and caregivers on condition self-management. Care managers can connect your patients with supportive services in the community. Care management staff will attempt to contact the members they feel could benefit from the complex case management program. Enrollment is voluntary and members can decide to opt out at any time. If the member agrees to participate, the care manager will assess needs and work with the physician, member, and caregivers to develop a case management plan. The care manager will contact the physician, when needed, to clarify the plan. If you would like to refer a UPMC HEALTH PLAN member to the complex case management program, contact us at Representatives are available from 8 a.m. to 4:30 p.m. Monday through Friday. 7

8 ACCOUNTABLEPROVIDER Self-disclosing POTENTIAL FRAUD The Office of the Inspector General (OIG) is encouraging health care providers to participate voluntarily in the self-disclosure of potential fraud. In an open letter to providers that is available on the website of the Department of Health and Human Services, the OIG outlines specific ways in which the selfdisclosure process can be improved. According to the OIG, the initial selfdisclosure submission should contain the following: A complete description of what is being disclosed. A description of the provider s internal investigation or a commitment on when it will be completed. An estimate of damages to the federal health care programs. A statement of laws potentially violated. In 1998, the OIG established the Provider Self-Disclosure Protocol (SDP) to encourage voluntary disclosure by health care providers of self-discovered evidence of potential fraud in order to ensure the integrity of the federal health care programs. The open letter states that providers will be removed from participation in the SDP unless they respond in a timely fashion and in good faith to requests for information from OIG. To view the entire open letter, you can follow this link: docs/ openletters/openletter pdf. Potentially harmful drug-disease interactions in the elderly The elderly are at increased risk of adverse effects with certain drugs. Risk of an adverse effect increases exponentially with the number of drugs used, partly because multiple drug therapy reflects the presence of many diseases and increases the risk of drug-disease and drug-drug interactions. Three drug-disease interactions are particularly common: A history of falls and a prescription for tricyclic antidepressants, antipsychotics, or sleep agents Dementia and a prescription for tricyclic antidepressants or anticholinergic agents Chronic renal failure and a prescription for nonaspirin NSAIDs or COX-2 selective NSAIDs It is important that you regularly review the drugs prescribed to elderly patients. In addition, you should pay close attention to post-hospital discharges or nursing home discharges and to patients who live alone or have a cognitive impairment. Electronic prescribing, limiting the number of physicians who are prescribing medications, and limiting (if possible) the number of medications for an elderly person can all help reduce drug-disease and drug-drug interactions UPMC Health Plan, Inc. All Rights Reserved. ACCT PROV-Q2 C (RT) 7/8/08 9M XX One Chatham Center 112 Washington Place Pittsburgh, PA upmchealthplan.com

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