ANNOUNCEMENTS

New Vendor for Payments

The implementation process to ECHO Health for electronic payments and remittances is continuing. We anticipate the transition will take place in Summer 2025. Additional communication, including instructions for working with ECHO Health, will be sent out 30 days prior to the change.

QUALITY IMPROVEMENT

Improving Medicare Patient-Reported Outcomes

Our network providers play a fundamental role in affecting patient perceptions surrounding their health care outcomes. Every year, the Centers for Medicare & Medicaid Services sends the Health Outcomes Survey (HOS) to a random sample of Medicare members in the summer. Two years later, those same members are surveyed again to look at changes in their self-reported health outcomes.

What is the purpose of the HOS?

The survey serves to provide a standardized understanding of patient outcomes around physical and mental health, fall risk and prevention, physical activity, and urinary incontinence. Our providers have a direct impact on patients’ perception of their health and quality of life. The tips and techniques below may help you enhance your Medicare patients’ health care outcomes.

Easy Tips to Follow to Improve Medicare Patient Health Outcomes

Mental Health

• Assess your patient’s symptoms of depression, anxiety, and other mental health conditions using a standardized, evidence-based, behavioral health screening tool, such as a PHQ-9.
• If a patient screens positive on a tool or exhibits symptoms of a mental health condition, develop a plan with them to help take steps to improve their mental health. Discuss exercise, identify stress triggers, talk about sleep habits, suggest that they connect with supportive friends and family, etc.
• Discuss options for therapy with a mental health provider.

Physical Health

• Ask your patient questions about their overall physical well-being, functional status, pain, and if their health limits them in performing daily activities (such as climbing stairs, working, etc.).
• Determine if your patient could benefit from physical therapy, acupuncture, a pain management provider, case management services, or another specialist or service.
• Partner with your patients to set physical health improvement goals (like healthy eating or exercise habits).

Bladder Health

• Initiate discussion with patients around urinary incontinence as this topic is often a sensitive one. Share educational materials about the condition.
• Ask your patients if they have any trouble with holding their urine, if they have had any accidents, and how it may impact their daily activities (e.g., sleep, social situations) and quality of life.
• Explain how common urinary leakage is, especially as we grow older. Discuss treatment options such as pelvic exercises, dietary changes, bladder training, medicines, and surgery.
• Refer your patients to specialists, if needed (e.g., urologist, OB/GYN).

Slips & Falls

• Review your patients’ fall risk by conducting a fall risk assessment. You can use a tool like this “Stay Independent” assessment from the Centers for Disease Control and Prevention. Ask questions about falls in past year, feeling unsteady, and worries about falling.
• Discuss fall prevention interventions including exercise and balance activities, physical therapy, a routine hearing and vision test, and home safety interventions (e.g., grab bars in bathroom, reducing trip hazards, use of nightlights).
• Conduct a regular medicine review with patient to see if there are medicines that increase the likelihood of falls.

Physical Activity

• Assess your patients’ physical activity levels, including both aerobic and strength training activity.
• Discuss the health benefits of staying active (e.g., mental health, physical functioning).
• Develop exercise strategies that match your patients’ abilities.
• Offer ideas where patients can engage in activities (e.g., YMCA).

Wellness Visits & Preventive Screenings

Wellness and preventive care screenings allow practices to gather valuable information about patients, including medical and family history, health risks, key vitals, and social determinants of health (such as housing, transportation, and food). The purpose of these visits is to review each patient's overall physical health and psychological well-being and then develop a personalized wellness plan. These screenings provide opportunities for providers to assess and improve the quality of care, engage patients in their own health, support healthier communities, and—most importantly—save or extend lives.

The following screenings provide an opportunity for wellness discussions, early intervention and care planning at those visits:

• Blood Pressure Screening: Ensure blood pressure is taken at each visit and that a repeat blood pressure is obtained for high readings (>140/90) to ensure accuracy.
• Colorectal Cancer Screening: The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer in adults age 45-75. The standard of care is a colonoscopy screening every 10 years or sooner, based on risk factors and results.
• Breast Cancer Screening: The USPSTF recommends that women who are 40-74 years old get a mammogram every 2 years. This has changed from the prior year where the recommendation was that women in their 40s make an individual decision with their clinician on when they should start screening, taking into account their health history, preferences, and how they value the different potential benefits and harms.
• BMI: Obtain a BMI each year and discuss ways to improve health with physical activity and nutritional changes. Ensure all child and adolescents visits have BMI percentiles identified and plotted on a growth chart.
• Depression Screening: Obtain a PHQ-2 each year at a minimum. If your patient scores higher than 2, complete a PHQ-9 and provide interventions to help decrease depression.
• Anxiety Screening: Obtain a GAD-7 each year. If your patient scores higher than 9, further assessment is warranted while providing interventions to help decrease anxiety.
• Unhealthy Alcohol Use Screening and Follow-Up:  Obtain an AUDIT each year or administer a single-question screening such as: “How many times in the past year have you had 5 (for men) or 4 (for women) or more drinks in a day?” Provide feedback on harms, high-risk situations, and help motivate reduced drinking.
• Social Determinants of Health (SDoH): This tool from the American Academy of Family Physicians can be used to screen patients for SDoH, identify community-based resources to help them, and work with patients to develop an action plan to help reduce health risks, ensure safety, and improve outcomes.
• Tobacco Screening: Ask about and provide resources to patients to assist in tobacco cessation.
• Immunizations: Become familiar with provider resources as they relate to immunization schedules for children, adolescents, and adults.

CREDENTIALING

Reimbursement Policies

Just a reminder, there are reimbursement policies on the provider page of each website. These policies contain useful information on how certain services are handled. 

Locum Tenens Providers

If a locum tenens provider will be filling in for more than 60 days, they must be fully credentialed. For coverage lasting less than 60 days, the provider may be provisionally credentialed. Please indicate that the provider is a locum tenens and include their start and end dates on the Provider Update Form, available on the provider page of each website.

CAQH Application Reminders

Please update CAQH regularly with any new insurance information, locations, or other changes. This is especially important when a provider changes locations or practices. We are now required to collect provider race and ethnicity from credentialing applications. To avoid delays, please ensure this information is included on the CAQH application.

UPCOMING EVENTS

MAHP Holiday Hours

Please keep in mind that Medical Associates Health Plans (MAHP) will be closed on Friday, July 4th.

During this time, our Provider Portal is available. Additionally, you may contact Patient Services at 563-584-3110 for emergencies.

RESOURCES