February 2017
Register today for the CO QPP Coalition webinar

Please join the Colorado QPP Coalition for a webinar on the basics of the Quality Payment Program, including the Merit Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model tracks, and the support available to navigate and succeed in Medicare's value based program. It will be held Thursday, Feb. 16, 2017, 12:15-1:15 p.m. Panelists are Mark Levine, MD, Barbara Martin, Monica Morris, MD, and Kyle Knierim, MD.

Click here for the direct registration link. This webinar will be recorded and archived for those who can't participate live.

Colorado Medicaid interChange: Guide to Go Live

On March 1, 2017, the Department of Health Care Policy and Financing (Department) will launch a new Claims Payment System, the Colorado interChange, for processing payments for services rendered on behalf of Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) members. In addition, the new Provider Web Portal launched Feb. 6, 2017, and a new Pharmacy Benefits Management System (Pharmacy Point of Sale system) will launch Feb. 25, 2017. This will not only be a transition to new systems, but to new vendors and new processes as well.
The Department has created a guide (click here or the image below) to help inform and prepare providers for these changes. This document contains general guidelines for our providers and is not intended to provide comprehensive guidance for every situation.

SIM office to release cohort 2 RFA

The SIM office will release its  request for applications for cohort 2 on Feb. 15, and has developed a quick-hit resource that outlines  benefits to encourage participationRead 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:
CMS, AMA and others call for prior authorization reform

A coalition that includes the Colorado Medical Society, American Medical Association and 15 other health care organizations released a set of 21 principles on Jan. 25 for health plans, benefit managers and others to use to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs. 

Requiring pre-approval by insurers before patients can get certain drugs or treatments can delay or interrupt medical services, divert significant resources from patient care and complicate medical decisions, the coalition stated in a press release. Given the potential barriers that prior authorization can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with the newly created set of 21 principles. 

Prior authorization programs could be improved by applying the principles' common-sense concepts grouped in five broad categories: 
  • Clinical validity,
  • Continuity of care,
  • Transparency and fairness,
  • Timely access and administrative efficiency, and
  • Alternatives and exemptions.
Read the full set of reform principles  here .
Judges block Aetna-Humana, Anthem-Cigna mega-mergers

Federal trial court judges, in tough-worded opinions, have blocked in back-to-back sequence the mega-mergers proposed by Anthem-Cigna and Aetna-Humana. On Jan. 23, U.S. District Judge John Bates ruled against Aetna, and on Feb. 8, U.S. District Judge Amy Berman Jackson, citing similar anticompetitive concerns as Judge Bates, ruled against Anthem. Anthem has indicated they will appeal the ruling. Both plans, if these rulings are sustained, would be required to pay to their respective partners substantial sums, totaling between them over $2 billion. 

Judge Jackson wrote: "Anthem is asking the court to go beyond what any court has done before: to bless this merger because customers may end up paying less to health care providers for the services that the providers deliver even though the same customers are also likely to end up paying more for what the defendants sell," an important acknowledgment by the court of the monopsonistic consequences of mega-mergers. 

Judge Bates additionally observed, after Aetna pulled their exchange business out of 11 of 17 states, including markets where they competed head-to-head with their betrothed, Humana, "Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger." The court's ruling sets an important precedent by acknowledging, as the AMA, Colorado Medical Society and other state medical associations argued, that Medicare Advantage is a separate and distinct market that does not compete with traditional Medicare, a legal fiction Aetna was promoting in order to justify substantial consolidations of those programs with Medicare Advantage competitor, Humana. 

AMA attorneys worked closely with CMS and the other high-concentration states, providing valuable physician survey data and experts to buttress the case for the Department of Justice. "This collaboration between the AMA and state medical societies made for a powerful case by the DOJ against some of the largest health plans inthe country," said CMS President Katie Lozano, MD. 

She warned, "This was an important pushback against what will likely be a determined, sustained effort by the health plans." 

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Take Credit Cards? Is Your Practice Ready for the Oct. 15 EMV Deadline?

Important! What your practice needs to know about switching to EMV: Click here.

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