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ACN Advance - May 2020

Regional Provider Meetings

Adaptability, Technology Highlight COVID-19 Survey Responses

Using a PAP Can Support Patient Care

A Reminder About Sharing Passwords and Login Credentials

News Roundup

Welcome, New Provider Organizations!

As our community and the country continues to fight the COVID-19 pandemic, we’ve seen and heard the numerous challenges and stresses placed upon your practice and staff the past few months. Arizona Care Network is here to support your practice and patient care. During this pandemic, we’ve put together a collection of resources and documents that can help your practice navigate both clinical and administrative challenges stemming from COVID-19. Available resources include:

Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org with any questions, feedback, or additional support. Your exceptional hard work and dedication to your patients is gratefully appreciated during these challenging times. Together, we will successfully navigate this pandemic and, in turn, become a stronger community.

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Regional Provider Meetings Coming June 23-24

Mark your calendar: The 2020 Regional Provider meetings are currently scheduled for this summer:

Enjoy a catered dinner, networking opportunities, and updates from ACN’s Executive Leadership Team on news and important organizational initiatives happening in 2020. Watch for more information in the coming weeks via Bulletin email notifications. Please note: For the health and safety of everyone, Regional Provider meetings are subject to change due to COVID-19. Watch for additional updates and upcoming detailed communications as events warrant. Please RSVP to your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org so we can keep you updated if the meeting dates change.

Thank you to everyone for participating in the COVID-19 Provider Survey. Your information and feedback will help ACN:

  • Keep the Care Coordination and Concierge teams informed of changes, new services, etc. implemented by your practice to better assist in supporting your patient care
  • Respond to any questions from payers about what your provider-led network has implemented/changed in response to COVID-19

More than 70 ACN-affiliated practices – primary care, specialists, facilities, behavioral health, and multispecialty – shared changes they’ve made during the COVID-19 pandemic. Among the highlights:

  • Nearly 80 percent of practices have added virtual and/or telehealth options for established patients
  • 74 percent have incorporated virtual visits via video for established patients
  • 59 percent have incorporated virtual visits via video for new patients
  • 50 percent added telehealth visits via telephone for new patients
  • 28 percent offer either in-office or drive-thru COVID-19 testing for established patients
  • 21 percent offer either in-office or drive-thru COVID-19 testing for new patients

View Complete Results of the ACN COVID-19 Survey. These survey results have further solidified the commitment to your patients, along with your practice’s ability and willingness to quickly adapt during this evolving and challenging time. Your efforts are admirable, inspirational, and greatly appreciated.

By Gary Addis Medicare Beneficiary Representative, ACN Board of Managers Please note: The following content is for informational purposes only and is not intended as professional medical advice. I recognize a complicated relationship exists between drug companies and physicians. Although drug companies have their own reasons for supporting Patient Assistance Programs (PAP), the immediate benefit often means a patient gets the medication at little or no cost and should be utilized. We know from multiple studies that up to 1/3 of seniors on Medicare fail to adhere to medication regimens due to cost issues: drug costs themselves, Part D premiums, and/or copays under a Part D Drug plan. Regardless of the reason or age of the patient, medication noncompliance is one of the leading costs of ER and Urgent Care visits as well as recurring hospitalization in Medicare recipients. Social Security reports that the mean monthly anticipated benefit for 2020 Social Security recipients in Arizona is $1,557. Deduct the Part B Medicare Premium of $144.60, leaving an actual received benefit amount of 1,412.40. For approximately 45% of our local senior citizen population, this is their only income. Anecdotally, in talking with pharmacists as well as groups of seniors, electronically transmitted orders are often left at the pharmacy counter once the patient learns of the cost of the copay. Additional orders are often ignored because of the cash pay for those with no drug coverage, and when the copay or cash payment is based on a 90-day supply, while the patient is living on month-to-month Social Security income. A 25% copay is significant for those on limited income. PAP Qualification Process The Patient Assistance Programs generally have a simplified process for qualification:

  • The patient fills out a one-page form, attaching copies of insurance card and ID and providing income information (if necessary)
  • The provider fills out a one-page form with identifying information and a prescription
  • The provider's office either faxes the information directly to the PAP or provides the completed form and medication order to the patient who then mails into the PAP

Here are two examples from my own experience:

  • Drug A has a Medicare contracted price of $1840 for a 90-day supply; my copay is $450.00. Assuming I have satisfied my Part D deductible of $435, my Part D plan would be charged $1390 per quarter, exceeding the total benefits available by the third quarter of the year and placing me in the donut hole. Using a PAP, I receive a 90-day supply of this drug delivered directly to my home at no cost.
  • Drug B is not covered by my Medicare Part D plan. The lowest available price is $370 for a one-month supply at Costco. Using a PAP, I presented my pharmacy benefit card to my local pharmacy and received my medication at no cost.

Resources to determine qualification In general, once qualified, a patient can receive the medication at no cost, whether it is picked up at the pharmacy, shipped directly to the patient, or picked up at the doctor’s office. HIPAA prevents the PAP from providing any information to a drug manufacturer representative, and further prevents a rep. from delivering a patient's medication to a physician's office (which has been voiced as a concern). Medicare offers an excellent resource to determine if a medication is covered by a PAP. A provider/patient/care coordinator/medical assistant can enter the name of a drug and immediately determine if a PAP is available. Information, a link to the appropriate site, and a toll-free number is provided. Additionally, numerous drug companies have banded together to create a free, centralized resource to assist qualifying patients in finding PAPs via an organization named Partnership for Prescription Assistance. I believe that PAPs can help address the issues caused by non-adherence to medication regimens for both Medicare and non-Medicare covered lives. We should assist patients in being able to access their medications with PAPs as a solution worth considering.

A friendly reminder to please do not share user login credentials and passwords. Even with the best intentions, important and/or private information can be compromised that can ultimately make your practice victim to a malicious cyberattack. Reasons Never to Share Login Credentials and Passwords:

  • It is extremely difficult, if not impossible, to determine the person responsible for improper access or a breach.
  • Allows employees to access all systems rather than only those needed to perform his/her work function(s)
  • Former employees could access your databases after separation of employment
  • Contracts with other institutions (ACN and/or other ACOs, IPAs, labs, facilities, etc.) may contain specific clauses regarding information sharing for which violations could result in contract termination

Best Practices Ideas for Login Credentials and Passwords:

  • Establish written policies, including:
    • Notifications that sharing passwords and login credentials is never acceptable
    • Disciplinary action for sharing of login credentials and/or passwords
    • Employee responsibilities and protocols to report any instances of password sharing
  • Work with your Electronic Medical Records (EMR) vendor to:
    • Ensure system access for former employees is immediately revoked
    • Ensure your organization’s system access is appropriate relative to his/her role
  • Charlton Wilson, Chief Medical Officer for Mercy Care Arizona, conducted an hourlong presentation and Q & A session toward helping your practice’s Mercy Care patient assignment, improve patient care, and foster efficient documentation. The entire presentation and discussion is available in the Provider Portal.
  • Four Valley hospitals were named among the best in the nation for 2020 by Health Grades: Chandler Regional Medical Center, Dignity Health – Mercy Gilbert Medical Center, and St. Joseph’s Hospital and Medical Center.
  • ACN Population Pharmacist Jason Kwan, PharmD, recently shared his knowledge and provided helpful tips for patients on ways to avoid Chronic Kidney Disease (CKD).
  • Arkangel Endocrinology & Diabetes (Phoenix)
  • eInfectionMD (Phoenix)
  • Lilac Ob-Gyn (Chandler)
  • Ocotillo Primary Care (Chandler)
  • Paramount Behavior Health Services (Glendale)
  • Sarita S. Sharma, MD (Phoenix)
  • Trident Health Center (Peoria)

You can also view a list of practices and providers no longer participating in ACN.