Summer 2017
Doctor's Note

Dear Colleagues, 
This issue contains a number of articles to help you and your team stay informed about the many approaches we are taking to improve our collaboration with you. A few examples are:
1) Detailed medical policy updates
2) HEDIS measurement updates
3) Communication of changes in viscosupplementation injection coverage (for example, knee injections)
4) Information related to the Provider Portal
As always, it is our goal to provide you with the resources and support you need to care for your patients who are also our members. We aim to make your work with us intuitive and seamless.
If you have any questions, you can contact me at 608-977-8981 or

Best of health,

Michael Ostrov, M.D., M.S.
Vice President and Chief Medical Officer
Four new HEDIS® 2017 measurements help track health outcomes

The Healthcare Effectiveness and Data Information Set (HEDIS) is vital to Arise Health Plan. HEDIS measures track a health plan's and physician's ability to manage health outcomes. Generally, strong HEDIS performance reflects enhanced quality of care. With proactive population management, physicians can monitor care to improve quality while reducing costs.
The new HEDIS technical specifications for 2017 include four new measures, changes to seven existing measures, and retirement of one measure. Here, we highlight the four new measures published by the National Committee on Quality Assurance (NCQA).
New Measures
Standardized health care-associated infection ratio: This measure assesses publicly available data from CMS' Hospital Compare to provide a gauge of the potential infection exposure risk to members admitted to the health plan's network hospitals.  
This patient safety measure reports standard infection ratios (SIR) for four different health care-associated infections (HAI):
  • Central line-associated blood stream infections (CLABSI)
  • Catheter-associated urinary tract infections (CAUTI)
  • Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA)
  • Clostridium difficile intestinal infections (CDIFF)
Follow-up after emergency department visit for mental illness:  This measure assesses the percentage of emergency department visits for members age 6 and older with a principal diagnosis of mental illness, who had a follow-up visit for mental illness within seven days and 30 days of the emergency department visit.
Follow-up after emergency department visit for alcohol and other drug dependence:  This measure assesses the percentage of emergency department visits for members age 13 and older with a principal diagnosis of alcohol or other drug (AOD) dependence, who had a follow-up visit for AOD within seven days and 30 days of the emergency department visit.
Depression remission or response for adolescents and adults:  This measure assesses the percentage of members age 12 and older with a diagnosis of depression who had evidence of response or remission of their symptoms 5-7 months after an elevated PHQ-9 score (PHQ-9 is a recognized depression screening tool).
We thank you for giving our members the highest quality care possible. Working together to meet these benchmarks, we have the best chance of improving our members' health outcomes and, ultimately, their quality of life.
Postpartum depression screening is encouraged

According to the American College of Obstetricians and Gynecologists (ACOG), perinatal depression is one of the most common medical complications associated with pregnancy. The organization recommends women be screened at least one time for depression within the perinatal period.¹
This year, we will be looking at the percentage of our members who were screened for depression at their postpartum visits. We will be encouraging members to ask their practitioners about postpartum depression screening via our member newsletter. Included below are some recognized tools used for depression screening:
If a patient scores positive for depression, please consult with a behavioral health practitioner.
¹The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression.   Published May 2015. Reaffirmed 2016.
Diabetes screening data being reviewed to encourage coordination of care between medical, behavioral providers

HEDIS (Healthcare Effectiveness Data and Information Set) has several measures of performance on specific dimensions of care and service. One of these measures looks at the percentage of members-ages 18-64, with schizophrenia or bipolar disorder, who are taking an antipsychotic medication-to identify if they were screened for diabetes within the calendar year. Even though this measure is specific to the Medicaid population, we will be reviewing data for the HMO/POS product lines to encourage continuity and coordination of care between medical care and behavioral health care.
For more information, there is a 2015 review article in the International Journal of Endocrinology. The authors recommend frequent screening for diabetes when starting an antipsychotic. Also check out table 1, " Specific considerations for diabetes treatment in schizophrenic patients ."
Viscosupplementation injection now considered unproven   

Effective July 1, 2017, all forms and brands of hyaluronan and derivatives used as viscosupplements will be considered unproven, and therefore not covered, to affect health outcomes in the treatment of osteoarthritis and other related joint conditions. The accumulated scientific evidence has failed to support the efficacy of the treatment or improved outcomes for osteoarthritis.
Years ago, viscosupplementation was proposed for the treatment of osteoarthritis of the knee, showing promise in delaying the need for--or even presenting an alternative to--total knee replacement. It became a common treatment. However, in recent years, the scientific evidence no longer supports this treatment.
On May 18, 2013, the American Academy of Orthopaedic Surgeons (AAOS) published the Treatment of Osteoarthritis of the Knee Evidence-Based Guideline 2nd Edition, which included a Strong Level Recommendation against using hyaluronic acid for patients with symptomatic osteoarthritis of the knee. View the statement online .
The evidence for continued use of hyaluronan v iscosupplementation became a subject of controversy. Results of additional research and analyses continued to be published.
By February 2017, MCG, one of our primary evidence-based resources, changed its previous clinical indications to "Current Role Remains Uncertain." New evidence that resulted in this change included several analyses published in 2015 and 2016, which concluded that there was little or no improvement in pain and function for patients with knee osteoarthritis treated with intra-articular hyaluronic acid, and there remained uncertainties about the clinical benefit of this treatment; further high-quality studies were recommended. Mention of the AAOS recommendation against viscosupplementation was also made.
In view of this recommendation and numerous other evidence-based sources, our Medical Policy Committee now considers hyaluronan viscosupplementation unproven to affect outcomes in the treatment of osteoarthritis and other related conditions for all joints; therefore, it is not covered.
Questions and comments can be sent to the Medical Policy Committee at . For questions regarding medical coding related to Medical Policies, please contact the Code Governance Committee at .
Quarterly Medical Policy Updates

The Medical Policy Committee met this quarter and approved the medical policies due for annual review.
Please be sure all doctors, other clinical staff, and office staff are aware of these changes before submitting requests for coverage. We ask that you share these policy changes with providers who may be ordering or performing services and clinicians who may be referring patients for services.
The complete library of our medical policies can be found at Arise Medical Policies. Our Prior Authorization list can be found at Arise Prior Authorization List . No password required!
Specific questions or comments regarding development of policy content may be directed to the Medical Policy Editor at or 800-333-5003 ext. 77196.
Affirmative statement on incentives

Utilization Management (UM) decision-making is based only on appropriateness of care and service and existence of coverage. The organization does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision-makers do not encourage decisions that result in underutilization.
Enroll today for Electronic Funds Transfer

Improve efficiency and go green with our Electronic Funds Transfer (EFT) direct deposit service. When you use EFT, you no longer have to wait for paper checks to be delivered through the mail. Instead, your payment is deposited right into your checking or savings account. This environmentally responsible electronic process uses less paper.
Your Electronic Remittance Advice will be your office's notification of the payment that will be posted to your account. Notification of your payment into your account will come from your bank. Please contact your bank for their notification procedures.
All you need to get started with EFT is to complete the Provider Management of EFT Enrollment Form .
Provider Portal tips: One sign-on for three insurance entities plus where to find network information

If you are currently using our Provider Portal, you are aware that your one account will provide information for WPS Health Insurance, Arise Health Plan, and Aspirus Arise members. As shown in the picture below, the Portal now clearly identifies which insurance entity applies to the member or claim in question.

Note: Not all providers are contracted with all three insurance entities. Your current Agreement specifies the insurance entity that pertains to your office/facility.

Where to find provider network for a member 
The Patient Inquiry Screens, as seen below, now reflect the provider network(s) that are tied to a member's plan under the Find a Patient Search Results page and Patient Information Detail page.

Be sure to check the effective dates of the member's policy, as the provider network will remain on the screen even if the plan has terminated. Should a member change networks with no lapse in coverage, two rows will be reflected; one for the current network and one indicating the previous network with applicable dates. "No Network Found" will be indicated for policies that do not have networks, such as a dental plan.

Arise Health Plan | P.O. Box 11625 | Green Bay, WI |
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