ACN Advance - September 2024

Medica Departs Arizona Market in 2025

Updated HEDIS Measures for 2025

Coming in October: Behavioral Health Listings

Flu, Covid Booster Vaccines Now Available

Quality: Cervical Cancer Screenings

Pharmacy: Benefits of Home Infusion vs. In-Clinic Infusion Therapy

Pharmacy: Introducing the Medication Therapy Management Program

News Roundup

Welcome, New Provider Organizations

Medica Departs from Arizona Market in 2025

Since entering the Arizona market in 2022, Arizona Care Network has served as Medica’s exclusive network for Pinnacle, the individual and family plan (IFP) it offers on the ACA Exchange. Medica has notified ACN of its decision to withdraw from the Arizona market, effective Dec. 31, 2024. Based in Minnesota and operating primarily in states throughout the upper Midwest, the change will allow them to focus on core products and geographies going forward. Medica’s leadership holds the providers in our network in the highest regard and expressed appreciation for the network’s efforts in caring for the patients enrolled with Medica during the past three years.

• Earlier this summer, Medica (Pinnacle) members received this letter informing them of Medica’s decision to withdraw from Arizona, effective Dec. 31, 2024.
• ACN will send currently attributed Medica (Pinnacle) members a notification by Nov. 1, reminding them of Medica’s decision. The letter will include additional information and available resources to help choose a health plan in 2025 that offers the best coverage for the member’s needs, including access to the doctors and healthcare facilities they enjoyed under Medica (Pinnacle).
• ACN is finalizing a partnership with a new payer organization, beginning in 2025. Watch for further Bulletin and Newsletter communications during Q4.

Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org with any questions or feedback.

To improve its quality measurement and reporting, the National Committee for Quality Assurance (NCQA) updated its HEDIS measuresfor the 2025 measurement year. Overall, the NCQA added three HEDIS measures, retired four measures and made smaller changes across multiple measures. The organization continues its transition to Electronic Clinical Data Systems (ECDS) reporting.

New HEDIS Measures

• • Documented Assessment After Mammogram. The percentage of episodes for members 40–74 years of age with mammograms documented in the form of a BI-RADS assessment within 14 days of the mammogram.
  • Follow-Up After Abnormal Breast Cancer Assessment. The percentage of episodes for members 40–74 years of age with inconclusive or high-risk BI-RADS assessments that received appropriate follow-up within 90 days of the assessment.
  • Blood Pressure Control for Patients with Hypertension. The percentage of members 18–85 years of age who had a diagnosis of hypertension and whose most recent blood pressure was <140/90 mm Hg during the measurement period (the measure is stratified by race and ethnicity).

Changes to Existing HEDIS Measures

• • Eye Exam for Patients with Diabetes. NCQA retired the Hybrid Method; this measure is now reported using the Administrative Method only.
  • Follow-Up After Emergency Department Visit for Mental Illness and Follow-Up After Hospitalization for Mental Illness. Updating denominator criteria to include phobia diagnoses, anxiety diagnoses, intentional self-harm X-chapter codes and the R45.851 suicidal ideation code.
  • Use of High-Risk Medications in Older Adults. Removing and adding medications and regrouping some medications into different “drug classes” to align with the updated American Geriatrics Society (AGS) criteria.
  • Well-Child Visits in the First 30 Months of Life; Child and Adolescent Well-Care Visits. Removing telehealth visits that was temporarily added during the COVID-19 pandemic.
  • Acute Hospital Utilization. Including the Medicaid product line for members 18–64 years of age.
  • Adult Immunization Status. Adding an indicator assessing hepatitis B immunization for adults 19–59 years of age, removed the herpes zoster live vaccine from the existing herpes zoster immunization indicator, and is revising the numerator criteria to assess receipt of the recombinant zoster vaccine.
  • Chlamydia Screening. Updating the Chlamydia Screening in Women measure to include transgender members recommended for routine chlamydia screening.

ECDS Reporting

• • Retiring the administrative and hybrid reporting methods for:
    • Childhood Immunization Status
    • Immunizations for Adolescents
    • Cervical Cancer Screening

Only the ECDS Method will be used for these measures.

Retired Measures

• • Care for Older Adults. Pain Assessment indicator
  • Antidepressant Medication Management

View the full HEDIS technical specifications for more information. Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org with any questions or feedback about HEDIS and the Quality measures.

To further support in-network utilization and care coordination between primary care and specialist physicians, in-network behavioral health listings will be available in the next couple weeks from your Clinical Performance Consultant. The .PDF document is a comprehensive list of ACN-participating mental and behavioral health providers within the Central Valley, East Valley, and West Valley, arranged in alphabetical order. The listings also note practices which accept telehealth appointments. Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to receive these quarterly-updated listings, or with any questions.

New vaccines are available to your patients this fall: a COVID-19 booster, a respiratory syncytial virus (RSV) vaccine, and updated flu shots. Anyone age 6 months or older is recommended for the newest COVID-19 booster from either Pfizer or Moderna. Studies suggest the effectiveness of the current booster is longer lasting than last year’s booster. The CDC recommends patients receive booster vaccines in late October, a few weeks before peak season for flu begins in November. The CDC also recommends eligible patients who did not receive an RSV vaccine last year receive it this year, approximately two weeks after the flu/COVID vaccines. These vaccines are available at no-cost to most patients with health insurance. Those without insurance may be eligible for free vaccinations through county or state health programs. Previously available COVID vaccines through the Bridge Access Program expired in August. Need additional support? ACN’s Care Coordination team can help your patients schedule any vaccine or booster appointments: Call (602) 406-7226 or email carecoordination@azcarenetwork.org.

Quality Corner: Cervical Cancer Screenings

For women ages 21-65, cervical cancer screening is a simple and important first step toward prevention, and, if necessary, treatment. And it can begin with asking patients a simple question: “Have you recently been sexually active?” These screenings among your female patient population not only close important quality gaps, but can save time, medical costs, and even lives. Cervical Cancer tip sheet (.PDF) Additional 1-page tip sheets are available to your practice for a wide variety of wellness and preventative care situations, including:

• • Breast cancer screening
  • Colorectal cancer screening
  • Depression
  • Diabetes/A1c
  • Immunizations
  • Medication adherence
  • Opioids
  • SDOH
  • Tobacco screening, and more

Need support? ACN can help patients schedule a cervical cancer screening with your practice by calling (602) 406-7226 or email members@azcarenetwork.org. Contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to receive any tip sheets.

Pharmacy Corner: Benefits of Home Infusion Therapy

Tannaz Farahani, MPH, PharmD Manager, Population Health Pharmacy Arizona Care Network Infusion therapy is the intravenous or subcutaneous administration of drugs or biologicals to an individual patient. In many situations, therapy (whether via medications or chemotherapy, to name a few) may be conducted either at the patient’s home or in a medical facility. Although typically performed in facilities, where direct medical supervision is enhanced (particularly if there is a shortage of qualified staffing), there are many instances a patient (and/or a caretaker) would prefer to remain at home, where a trained professional can personally deliver such medications, education, and support.

Benefits of Home Infusion

• • Enhanced Patient Comfort and Convenience: Home infusion eliminates the need for travel, long wait times, and the anxiety that often accompanies visits to a medical facility. Patients can receive their treatment in a familiar environment, leading to a more positive overall experience and reduced exposure to other potential illnesses.
  • Social Determinants of Health: External factors such as available transportation and the cost of additional caretaker resources can make travel difficult for patients.
  • Improved Adherence and Outcomes: Studies indicate that patients who receive treatment at home often have better adherence to their therapy regimens. The convenience of home therapy can lead to more consistent medication administration and improved health outcomes.
  • Reduced Risk of Infections: By avoiding in-clinic visits, patients reduce their exposure to potential infections commonly found in healthcare settings. This is especially critical for immunocompromised patients who are more susceptible to infections.
  • Support for Caregivers: Home infusion allows caregivers to be more involved in the treatment process, providing them with the opportunity to assist with administration and monitoring. This involvement can strengthen the support system for patients.

Cost Benefits of Home Infusion

From a financial perspective, home infusion can significantly reduce healthcare costs. A few points to consider:

• • Lower Facility Costs: Home infusion eliminates many overhead costs associated with maintaining an infusion center, allowing for a more cost-effective model.
  • Reduced Hospital Readmissions: Patients who receive treatment at home often experience fewer complications and, as a result, a lower rate of hospital readmissions, which can be a significant cost driver.
  • Optimized Resource Utilization: By shifting appropriate patients to home infusion, in-clinic resources can be better utilized for those requiring immediate or intensive care, thus improving overall system efficiency.

Conclusion

As healthcare providers, it’s essential to consider innovative approaches that enhance patient care while also addressing cost concerns. Home infusion therapy stands out as a beneficial option that not only improves patient experience but also contributes to cost savings for the healthcare system. We encourage your practice to explore incorporating home infusion as a potential solution with your patients, if warranted. Together, we can provide your patients with high-quality, patient-centered care that meets their needs effectively, efficiently, and compassionately. For more information on implementing home infusion therapy, or additional patient support with medications, please contact me attannaz.farahani@azcarenetwork.org or your Clinical Performance Consultant.

Introducing the Medication Therapy Management (MTM) Program

Tannaz Farahani, MPH, PharmD Manager, Population Health Pharmacy Arizona Care Network Arizona Care Network is proud to launch a Medication Therapy Management (MTM) program. This initiative is designed to enhance patient outcomes by optimizing medication use, improving adherence, and ultimately reducing avoidable emergency room visits.

What is Medication Therapy Management (MTM)?

MTM is a comprehensive service and collaborative approach toward medication management. Our pharmacy department will work closely with you and your patients to:

• • Review Medications: Conduct thorough assessments of all prescribed medications to identify potential drug interactions, duplications, and other issues.
  • Develop Personalized Care Plans: Create tailored medication plans that consider the patient’s unique health status and needs, in collaboration with his/her provider’s care plan.
  • Educate Patients: Empower patients with knowledge about their medications, helping them understand the importance of adherence and potential side effects.

Why is MTM Important?

• • Enhance Patient Safety: By identifying and addressing medication-related problems, MTM reduces the risk of adverse drug events, which can lead to unnecessary hospitalizations.
  • Improve Clinical Outcomes: Better management of medications can lead to improved control of chronic conditions, reducing the need for emergency interventions
  • Close Pharmacy Gaps: MTM helps ensure patients are on the most appropriate therapies, addressing gaps in care that might otherwise go unnoticed.

MTM Impact on Emergency Room Visits

Research has shown that effective medication management can significantly decrease the number of avoidable emergency room visits. By ensuring that patients are on the right medications and understand their treatment regimens, we can help them avoid crises that lead to ER visits.

How To Get Involved?

We encourage you to refer patients to our MTM program who may benefit from comprehensive medication management. Our team is here to support you in improving patient care and outcomes. If you would like more information about the MTM program or how to refer patients, please contact me at tannaz.farahani@azcarenetwork.org. We look forward to collaborating with you to enhance the care we provide to our community. Thank you for participating with Arizona Care Network!

Network News Roundup

• • Follow us on Facebook, Twitter,LinkedIn, and YouTube 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 Maps are available to your practice anytime. Additionally, Behavioral Health, OB/GYN, Ophthalmology/Optometry, Physical Therapy and Radiology listings 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.
  • 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.orgto receive any/all tip sheets.
  • A 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.orgif your practice would like copies of this document.
  • Dignity Health and Arizona Diagnostic Radiology (AZDRG) are hosting a pair of CME opportunities at the Marriott Phoenix Chandler. Advances in Men’s Health (Sept. 27 from 12:30 – 5:30 p.m. More info. and RSVP here) features urologists, Drs. Rahul Mehan, MD and George Kallingal, MD, MPH. Areas of focus include screening and treatment for prostate cancer, sexual health dysfunction, and urinary dysfunction from prostatic issues. Breast Cancer Survivorship – Life on Treatment and Beyond (Oct. 4 from 12 – 5 p.m. More info. and RSVP here) features Drs. John Davis, MD and Emily Ho, MD, who will discuss breast cancer treatment and survivorship. A Q & A panel discussions and presentations that showcase a multidisciplinary approach will be included. Both CME opportunities are free, with lunch and happy hour cocktails and hors d'oeuvres included.
  • Due to upcoming holidays, here is the monthly Practice Manager Forum schedule for the remainder of 2024 (all PMFs are from 12:15 - 1 p.m. via Zoom): Oct. 24 (nutrition and diabetes with Amy McCallister, RD); Nov. 21 (topics TBD); Dec. 19 (Bronchitis/Bronchiolitis, Upper Respiratory Infection, Pharyngitis). Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to receive a meeting invitation.
  • Abrazo Arrowhead and Abrazo Heart are hosting a Physician Social for West Valley and North Valley primary care providers (MD, DO, APP) and their families on Oct. 5 from 11 a.m. – 2 p.m. at the Odysea Aquarium in Scottsdale. Admission is free including food and beverages, and various cardiovascular technological advances will be on display. RSVP is required. More information is available here.
  • Alignment Health Plan is conducting two annual enrollment webinars Oct. 3 (8 – 9 a.m.) and Oct. 9 (12:15 – 1 p.m.). Each webinar features 2025 member benefit updates, plan information, and clinical information. The webinars (attending only one webinar is needed) are open to all ACN providers and administrative staff. Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to receive a meeting invitation, which will be recorded and available from your CPC in the days following each webinar.
  • Aetna offers free Risk Adjustment Coding and support webinars. Each education webinar is approved for 1.0 AAPC CEU, and the coding CEUs can be used for AAPC continuing education requirements. Advance registration is required. Contact RiskAdjustment@aetna.com to register for a webinar or with any questions.
  • Abrazo West Campus began construction of a 24-bed Inpatient Rehabilitation Hospital next to its acute care hospital campus in Goodyear. Located within the Abrazo Litchfield Medical Building, the rehabilitation services offered will support patients recovering after traumatic injuries, cardiovascular surgery, stroke, and advanced spine care. It will offer rehabilitation services, including physical and occupational therapy, speech-language pathology, physiatry, internal medicine as well as surgical and medical subspecialty consultation services. The facility is scheduled to open in September 2025.
  • Phoenix Children’s opened its new Arrowhead Campus hospital in Glendale. This state-of-the-art, 175,000-square-foot hospital offers a comprehensive range of services, including inpatient care, a 24/7 emergency department, surgical care and advanced imaging services. More information is available here.

Welcome, New Provider Organizations!

• • AleraCare AIC (formerly Vasco Rx Specialty Pharmacy)
  • Be Well Family Care
  • Desert Spine and Sports Physicians
  • Maternal Fetal Medicine and Genetics
  • Maricopa Pulmonary Consultants
  • Latino Care
  • Lactation Consultants of America/Breastfed Babies
  • Thomas G. Hopkins, MD
  • Preventative Health Alliance (formerly Phoenix West Internal Medicine)
  • Stellar Medical Group
  • Sun Arizona Medical Group
  • UMPC

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