March 3, 2017
AMA sounds alarm about "political influence" in Anthem-Cigna deal
The American Medical Association expressed alarm over an implied deal that would allow Anthem's purchase of Cigna under newly appointed Justice Department officials from the administration of President Donald Trump.

In a Feb. 28 letter to Acting Assistant U.S. Attorney General Brent Snyder, the AMA said it was alarmed by "recent statements by Anthem, made in the Delaware Court of Chancery, asserting that the company expects to close its merger transaction with CIGNA through 'resolution with a new DOJ.'" (Emphasis added)

"An Anthem attorney stated in open court that the company believes its prospects for a timely closing are enhanced by a 'supportive' Vice President Mike Pence," wrote AMA CEO James Madara, MD, to the U.S. Justice Department. Pence is the former Indiana governor and Anthem is headquartered in Indianapolis. "There have also been press reports of settlement negotiations."

Anthem is appealing the February U.S. District Court ruling that blocked its merger with Cigna on grounds that it would violate federal antitrust laws by stifling competition and harming consumers by increasing health insurance prices and hindering innovation that could lower health care costs. The AMA, Colorado Medical Society and other members of the Block the Mergers Coalition opposed the Anthem-Cigna deal and assisted the Justice Department in its successful case to block the deal.

"We find it implausible that the U.S. Department of Justice (DOJ), eleven states and the District of Columbia -- that have diligently and successfully prosecuted this antitrust merger case -- could now be swayed to allow this merger to close pursuant to politically driven settlement negotiations as Anthem has suggested," Madara wrote in the letter. "To do so would cause irreparable harm to the integrity of the federal courts to adjudicate anticompetitive behavior in a fair and impartial manner, leaving consumers at risk. We strongly believe that political influence should play no role in the enforcement of the antitrust laws and urge you to vigorously defend Judge Jackson's ruling."

Susan Koontz, JD, Colorado Medical Society general counsel, wrote in a March 1 letter to the office of Attorney General Cynthia Coffman that CMS vigorously supports the AMA's respectful urging that the U.S. DOJ and state plaintiffs reject any offers to settle the Anthem-Cigna litigation.

Read the letters from CMS and AMA here.
CODE BLUE CMS LEGISLATIVE ALERT: Urge your state senator to support "deselect bill," SB 17-088
2-13-17 Senate Bill 17-088
View a video from the Feb. 13 hearing on SB 17-088

The Colorado Medical Society strongly supports SB 17-088: Transparency & Fairness: Standards in Network Selection/De-selection. The bill has been cleared for a vote on the floor of the Colorado Senate and needs support. CMS urges you to call your state senator to ask him or her to vote for SB 17-088. Find your senator's contact information by entering your address in the search box of the "Find my Legislator" tool on the Colorado General Assembly website.

In the current health insurance marketplace, carriers are limiting consumer choice of their physician through the use of limited or narrow provider networks. Instead of opposing this trend and fighting it, CMS has taken the posture of trying to help members prepare for narrow networks so they can qualify to be in-network and care for their patients.

SB 17-088 requires health plans to be transparent and fair about how these networks are developed, what the standards for participation are, and what the process is to select or remove (de-select) providers from those networks. Patients need to know what they are buying and physicians need to know what it takes to participate.

Watch the video from its initial hearing in February (above), and stay tuned for more on this bill.
There's still time to register for the second program in the free CMS Physician Leadership Skills Series -- and earn CME
Earn up to 1.5 AMA PRA Category 1 Credits™ at the next program in the CMS Physician Leadership Skills Series, exclusive and free for CMS members. Join from the comfort of your home: it will be held Monday, March 6, 6-7:30 p.m. by videoconference. Register here.

The topic of the March 6 program is goal-setting. Health care is experiencing an unpredictable future, and navigating what's next requires clear and careful development and execution of goals. For physicians, goal-setting is an often under-appreciated skill that is essential to ensure a meaningful and professionally satisfying practice.

Attend this session to develop or refine your goal-setting skills to help ensure the future you want for your practice, your profession and your patients.

Registration for the April 22 program in Denver is also open. The topic is "multi-generational leadership" and offers up to 3.5 AMA PRA Category 1 Credits™. Find more information on the full series, including the CME accreditation statements, and access registration here.
Resources available to aid in transition to the Colorado interChange and new Provider Web Portal
After several years of preparation, Go Live has arrived. As of March 1, physicians and practices will begin using the new Provider Web Portal to submit claims, update practice information, and verify eligibility.

Only physicians who have submitted an enrollment or revalidation application and have been approved can register for a Provider Web Portal account, check member eligibility or submit claims. Click here to begin an enrollment or revalidation application. Health First Colorado encourages providers to watch the training videos on the new Provider Web Portal and review Frequently Asked Questions (FAQs).

Questions? Call HPE's call center at 1-844-235-2387. You can also contact the call center to check member eligibility, provider warrant information or claim status information. The legacy web portal will be available to save reports until March 11, 2017. It cannot be used to check member eligibility, submit claims or check claim status and will no longer be available starting March 12.

Visit the Provider Resources webpage for many resources to assist with the transition, including the Guide to Go Live. Health First Colorado encourages providers to download and review the Guide to Go Live, even if you have done so before, because they have updated the document several times over the past few weeks and will continue to do so during the transition.

HPE will hold two daily webinars with providers to help practices successfully use the new provider web portal. The first session will take place March 3 at 8:30 a.m. and will focus on claims submissions. Click here to register for the webinar. A recording of the session will be made available for those who cannot join live.
Primary care practices: HIT and PCMH e-learning modules available
The Colorado Department of Public Health and Environment (CDPHE) and the University of Colorado Department of Family Medicine invite primary care practices to access a series of e-learning modules, which provide continuing medical education (CME) credits and are available at no cost:
  • Health Information Technology (HIT): modules provide comprehensive and practical information for primary care clinicians and staff regarding implementation of HIT to improve patient care (2.0 AAFP CME credits).
  • Patient-Centered Medical Home (PCMH): modules provide a comprehensive framework for practice transformation in primary care (12.0 AAFP CME credits).
To access the e-learning modules, please visit http://hit.pcmhelearning.com and click on the "Sign Up" button. For more information, please contact Renzo Amaya at renzo.amaya@state.co.us.
RSVP for Let's Talk Behavioral Health - March 23, 9-11 a.m.
Let's Talk Behavioral Health, an event by Healthy Transitions Colorado, will be held March 23, 9-11 a.m., at the COPIC offices. The program features Paul Baranek, Education Coordinator for Beacon Health Options, and Toria Thompson, Behavioral Health Information Exchange Coordinator for CORHIO. Paul will discuss the functions of a behavioral health organization and how to access (or refer to) behavioral health services through Health First Colorado, Colorado's Medicaid program. Toria will provide an overview of CORHIO's upcoming pilot testing HIE exchange of behavioral health data.

Let's Talk is a new community forum series by Healthy Transitions Colorado that will tackle topics related to care transitions. Each quarter the group will host a meeting with experts who will provide background on the topic and an example of innovations. The event is free but space is limited. RSVP here.
Now available: SIM cohort 2 RFA
The SIM office has released its request for applications for cohort 2, and has developed a quick-hit resource that outlines benefits to encourage participation. Read this document, share with practice staff and colleagues, and see how you can integrate behavioral health and primary care to improve patient outcomes with SIM. 
 
Additional resources:
Colorado Primary Care Collaborative to host payment and delivery reform event
Mark your calendars: The Colorado Primary Care Collaborative will host a convening event on June 8, 2017. The theme is "Primary Care Payment and Delivery Reform: What's on the Horizon," and it will be held at the Embassy Suites Denver - Tech Center, 10250 E. Costilla Ave., Centennial, CO 80112 from 8:15 a.m. to 4:15 p.m.
 
Topics include the state and national payment reform and the central role of primary care, payment models for primary care, and payment reform from the perspective of employers and insurers. Go to www.coloradoafp.org/cpcc to view the full agenda and register.
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