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Newsletter

ACN Advance - March 2023

COVID-19 Public Health Emergency Concludes on May 11

Important Mercy Care Member Re-Determination Information

Remote EMR Access Benefits Your Practice

Stay Connected to Important ACN Updates

Benefits of Home Infusion Therapy

GLP-1 Weight Loss Medications for Non-Diabetic Patients

News Roundup

Welcome, New Provider Organizations

Happy Anniversary: A Decade Strong and Growing

As Arizona Care Network celebrates our 10th anniversary, we give thanks to the thousands of clinicians, administrators, and team members who have partnered with one another and with ACN to bring tremendous value to our healthcare community. In building upon a successful 2022, we’ve started initiatives in 2023 that lay a foundation for the future:

  • enhanced coordination of care within the network,
  • outreaching and engaging patients on your behalf to improve outcomes,
  • more effectively capturing and sharing clinical information with our care teams and payer partners, and
  • bringing new payer contracts and value-based opportunities to the providers that participate with ACN.

As always, our Care Coordination team is ready to support patient care with resources and services, and your dedicated Clinical Performance Consultant can be contacted directly or by email to ensure your medical group has access to the information and tools we offer to support your success. Happy anniversary and thank you for participating with ACN! Todd Ricotta CEO

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Earlier this year, the Department of Health and Human Services (HHS) announced that the Public Health Emergency (PHE) related to COVID-19 will end on May 11, 2023. Important information regarding the concluding PHE and the ongoing Re-Determination for Mercy Care members is included within this Newsletter. During the PHE, CMS used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure easier access to care for health care providers and beneficiaries. Some created flexibilities during the pandemic were recently expanded by the Consolidated Appropriations Act of 2023. CMS also made additional updates to telehealth and individual waivers that were initiated during the PHE.

Resources

Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org with any questions or support for your practice in transitioning out of the Public Health Emergency.

Due to the concluding Public Health Emergency (PHE) on May 11, all current Medicaid beneficiaries must re-apply with the Arizona Health Care Cost Containment System (AHCCCS) to determine future Medicaid eligibility. Previously, Medicaid beneficiaries were automatically re-enrolled during the PHE, regardless of eligibility. Beginning April 1, AHCCCS will begin dis-enrolling members who are not eligible for future Medicaid participation. AHCCCS and the Arizona Department of Child Safety (DCS) will update all information for members in foster care.

Next Steps for Member Re-Determination

  • Ensure each member’s mailing address, phone number, and email address on file is correct in the Health-e-Arizona Plus website. All members should login or call Health-e-Arizona Plus at 1-855-HEA-PLUS (1-855-432-7587), Monday through Friday from 7 a.m. to 6 p.m.
  • Review the Updating Your Contact Information flier available in English or Spanish to learn how to update contact information in Health-e-Arizona Plus website.
  • Members should watch their mailbox for a letter from AHCCCS about renewal of coverage. The letter will either inform each member of eligibility status and indicate either no response is needed or ask for additional information.
  • Members should respond to any requests from AHCCCS for more information to accurately determine eligibility.

Re-Determination Process

Beginning April 1, 2023, AHCCCS will begin disenrolling members who no longer meet Medicaid eligibility requirements. This process will take 12 months. Here’s what will happen:

  • If eligibility is continued, members will receive a summary letter indicating if the information on the summary is correct, no further action is needed.
  • Members whose eligibility cannot be automatically determined will receive a written request from AHCCCS that more information is needed within 30 days.
  • AHCCCS cannot disenroll a member whose mail is returned undeliverable until making other good-faith attempts to contact the member.

Members No Longer Eligible for Medicaid

For members whom AHCCCS determines are no longer eligible for Medicaid at the conclusion of the PHE, available coverage options and resources are available:

  • Members will receive a letter in the mail of when his/her/their enrollment will end, information on how to appeal that decision, and information about other health care coverage options available from Healthcare.gov.
  • Additional health care coverage options are available through:
  • Additional information and resources are available for providers via the Arizona Health Care Cost Containment System (AHCCCS) Toolkit.

If you have questions or would like additional support during the Re-Determination process, please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org.

To further ease your practice’s staffing and administrative burdens, Arizona Care Network can support your patient care through secure, remote EMR access that allows a specific ACN Quality Team member to identify possible Hierarchical Conditioning Category (HCC) coding opportunities for Medicare members, and potentially identify/close quality gaps. Remote EMR access also allows for faster, more efficient data abstraction. This reduces the admin workload of your practice in responding to medical record request faxes from ACN and abstracting the medical records. In addition, ACN can turn around payor requests during short quality reconciliation time frames. ACN can review more medical records with remote EMR access and overall, have a higher chance in achieving quality targets for shared savings for the provider network. The additional benefit of remote EMR access is ACN can expand the HCC Reconciliation program and assist you in identifying ACN members and their quality gaps. A Quality team member will review your daily appointment schedule and send you an ACN member’s quality gaps before their appointment. In addition, Quality measure tip sheets are available for you to print, or from your Clinical Performance Consultant. Please contact your CPC or email practicetransformation@azcarenetwork.org to begin remote EMR access and/or for any tips sheets.

To help your practice stay connected with important news, new initiatives, and other updates throughout the year, Arizona Care Network is requesting your provider(s) email addresses to improve ACN’s outreach efforts. By sharing your provider(s) email addresses, they will receive the quarterly ACN Advance Provider Newsletter, along with regular network updates, and other important communications that support your practice and patient care throughout the year. Simply click on the Provider Update Form to enter your provider(s) contact information. Email address information shared with Arizona Care Network will never be shared with any outside organization and will not be used to attempt to market or solicit any product. This is strictly for informational purposes, directly from ACN.

Contributed by Don Filibeck, PharmD, MBA, FASHP, FNHIA BCSCP Vice President, Clinical Services and Quality, Soleo Health Home infusion therapy has been available to patients since the 1980s, yet many people are unaware they can receive infused complex intravenous medications under the guidance of their prescribers from the comfort of their homes. The idea of receiving infusion therapy in the home may seem unfamiliar initially and likely poses many questions. What medical conditions can be treated with infusion therapy? Many complex conditions requiring infusion therapy can be managed at home or, at times, in alternate sites of care. These include, for example, neurological disorders, hematological illnesses, infectious diseases, primary and autoimmune deficiencies, heart failure, inflammatory ailments and nutritional/gastrointestinal disorders. Home infusion therapy offers various options for administering drugs for treating the aforementioned diseases and includes parenteral nutrition, cardiac infusion therapies for heart failure, immunoglobulins and many other biologics. What are the benefits of home infusion? Home infusion therapy allows patients of all ages to be considered for earlier discharge from the hospital or even a chance to avoid hospitalization altogether. The effectiveness of home infusion therapy has been widely documented, with research showing high levels of patient satisfaction with the treatment. Clinical outcomes are favorable, and patients are no more likely to experience side effects or adverse reactions at home compared to inpatient or outpatient settings. Various studies over the years have revealed the many benefits of home infusion. Some of these include, but are not limited to, cost savings for those receiving care in the home or at alternate sites of care; reductions in hospital stays and faster discharges; lowered risk of infection; better outcomes; and increased safety. Patients can reap some or all of these by opting to receive care in their home, as directed by their physicians. Will insurance cover infusion therapy in the home? Most commercial health insurance companies and some governmental payors cover home infusion therapy. While patients’ situations and insurance policies differ, companies providing home infusion therapy services offer benefits verification and obtain prior authorizations before starting care. Insurance companies are billed directly for services that have been verified upfront. Patients will learn about related costs such as co-pays or out-of-pocket responsibility from either the home infusion pharmacy or their insurance provider. How is a patient scheduled to receive home infusion therapy? Who administers it? Once patients are discharged from the hospital, emergency room or referred from a hospital outpatient infusion center or provider office and ready to receive therapy at home, a referring provider will send orders to a home infusion or specialty pharmacy provider. An infusion assessment is then set up with a clinical team spanning a specialized pharmacist and registered nurse who, in collaboration with the patient’s provider, determines the safest and easiest approach for administering medications. The infusion medication is then dispensed from an accredited pharmacy and delivered to the patient’s home. A nurse will either administer the therapy or teach the patient and caregiver how to administer the medication if required. Comfort levels increase as patients and caregivers become more familiar and independent with in-home therapy. While patients become self-sufficient in managing their care, it is important to note that their pharmacy is still in contact with them regularly. A nurse also visits periodically based on their medical condition and IV access. Home infusion therapy provides a safe, convenient, cost-effective alternative to traditional inpatient hospital care for many complex medical conditions. Determining if it is right for your patients can ultimately prove beneficial to all stakeholders involved in the continuum of care.

Contributed by Tannaz Farahani, PharmD Manager, Population Health Pharmacy Arizona Care Network Low medication adherence continues to be a health and financial hardship across the continuum of care. One contributing factor in this trend has been diabetic patient measures (2+ fills of a diabetic medication) but without diagnosis of diabetes. A common scenario is when a patient is prescribed GLP-1 Agonist for Weight loss without a diabetes diagnosis. Please consider the following when prescribing GLP-1 agonists for weight loss to patients that do not have a diabetes diagnosis: Wegovy (Semaglutide) and Saxenda (Liraglutide) are FDA-approved medications for weight loss. They are a GLP-1 agonist, which means they mimic a naturally produced hormone called glucagon-like peptide 1 (GLP-1). This hormone is partly responsible for regulating hunger. These are FDA approved to treat obesity and excess weight, and will not put the member in the diabetes measure (not stars medications).

Network News Roundup

  • Follow us on Facebook, Twitter, and LinkedIn for additional news, health-related content for providers and patients, organizational updates, and more.
  • Learn more about ACN’s Care Coordinationprogram and services designed to partner and support your practice in achieving healthy, cost-effective patient outcomes in thisvideo.
  • ACN’s improved Specialist Performance Reportsand Medical Neighborhood Mapsare available to your practice anytime. Additionally, Physical Therapy and Radiology listings quick reference guides are also available. Contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to receive any of these reports and/or maps, all of which are updated quarterly.
  • A 1-page Payer ID Card Quick Reference document is available from your Clinical Performance Consultant. This document contains samples of ID Cards from ACN payer partners, as well as contact information. Contact your CPC or email practicetransformation@azcarenetwork.org if your practice would like copies of this document.
  • Quality measure tip sheets are available from your Clinical Performance Consultant, including colorectal cancer screening, depression screening and follow-up, diabetes (A1C, Eye Exam, Nephropathy), Social Determinants of Health (SDOH), and Tobacco screening. These 1-page tip sheets (.PDF) include best practices, documentation requirements, and codes for your practice to help close quality gaps. Contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to receive any or all tip sheets.
  • Save the Date: During the March 30 Practice Manager Forum, ACN will discuss the recent CMS's five-year re-authorization and expansion of the Arizona Health Care Cost Containment System's (AHCCCS) Targeted Investment (TI), which supports mental and behavioral health, and SDOH initiatives, throughout Arizona. Please contact your Clinical Performance or email practicetransformation@azcarenetwork.org to participate in the March 30 forum. eVolvedMD recently wrote about the upcoming convergence of TI 2.0, behavioral health integration (BHI), and SDOH here.
  • Barrow Neurological Institute and the Lewis Headache Center are hosting a headache education symposium on Saturday, April 1, from 8 a.m.-3 p.m. at the Goldman Auditorium inside Barrow Neurological Institute. The symposium is open to all PCP and neurologists, and features a variety of neurological experts, lunch, and Q & A sessions. More information is available here. Registration is available here, and includes the symposium, program materials and continuing medical education (CME) credit.
  • Barrow is also hosting a seminar on Cushing’s Disease on Wednesday, April 12, from 5:30-6:30 p.m. via Zoom. Discussion topics include pituitary gland, drug therapies, and additional research underway. More information and registration is available here.
  • Dignity Health is hosting Modern Approaches to Inflammatory Bowel Disease program on Thursday, March 30, from 5:30-8 p.m. in the McAuley Conference Room (3rd floor) at Dignity Health Mercy Gilbert Medical Center campus. The program is open to all medical providers, and features a variety of educational and community education booths, presentations by surgeons and gastroenterologists, dinner, networking opportunities, and CME credits are included. More information and registration is available here.
  • Dignity Health cardiologist Dr. Robert Roberts recently shared his work around a DNA/genetics Clinical trial being conducted in connection with heart disease. Watch his AZTV (Channel 7) segment here. Patients interested in participating in Dr. Roberts’ research study can learn more here.
  • Abrazo Scottsdale Campus earned the Bariatric Institutes of Quality® (IOQ) designation from Aetna. Facilities may be selected to participate in the Aetna Institutes of Quality (IOQ) Bariatric Surgery network by meeting certain measures of clinical quality, cost efficiency and access for bariatric (weight loss) services. As an MBSAQIP-accredited comprehensive bariatric facility, the hospital demonstrates that it provides the support and resources necessary to address the entire continuum of care for bariatric patients.
  • Construction is underway for expansion of the Interventional Radiology and Pharmacy departments at Abrazo West Campus. The 6,900 square foot expansion will add a second Interventional Radiology suite and allow more efficient hospital Pharmacy operations for handling complex medications. The new Interventional Radiology suite is designed to offer minimally invasive procedures to diagnose and treat a wide range of conditions, including biopsies, angiography, angioplasty, and vascular procedures. The new additions for Interventional Radiology and Pharmacy are expected to be complete later this year.
  • The 8,500 square foot addition to Abrazo Arrowhead hospital’s specialty unit for preterm infant care is expected to be completed later this year. The existing Level IIIA perinatal care center continues to be open for patient care during construction. The addition will increase unit’s size from 21 to 35 beds and support enhanced capabilities to pursue certification as a higher Level IIIB Neonatal Intensive Care Unit for more complex maternal and neonatal medical conditions, obstetric, and fetal complications.

Welcome, New Provider Organizations!

  • Canyon Sleep Neurology and Wellness Group (PCCN)

You can also view a list of provider organizations no longer participating with ACN.